Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 8–10 Years After Inpatient Treatment

Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder

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.

Cognitive behavioral therapy for a Japanese woman with olfactory reference disorder (ORD) comorbid with schizophrenia: A case study

Background

Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive-compulsive disorder. Using this model, this study reports a successful treatment process of a 53-year-old female with ORD.

Case Presentation

The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4-week hospitalization period, high-intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety-seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention.

Conclusion

Following a seven-sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High-frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.

A brief course of digitally delivered cognitive behavioural therapy for the treatment of blood contamination-based obsessive-compulsive disorder: a structured case report

The lifetime prevalence of OCD in the UK is estimated to be between 1 in 100 and 1 in every 50 people. It is therefore necessary to explore innovations in practice to expand the reach of the gold standard therapeutic approaches of exposure with response prevention (ERP) and cognitive behavioural therapy (CBT). The COVID-19 pandemic has facilitated such innovations with several services accommodating changes to routine practice by utilising digital platforms to provide videoconference-delivered therapy. Despite a growing evidence base demonstrating efficacy and scope for the use of videoconference-delivered CBT for obsessive-compulsive disorder (OCD), there remains qualitative research collated from clinicians which suggests that a lack of practitioner confidence and a low belief in positive outcomes are barriers to adopting remote therapy practices for clinicians. Therefore, this structured case report describes the assessment, formulation, intervention and outcome of an 11-week videoconference-delivered therapeutic intervention. Reflections are made regarding the use of the digital platform throughout the intervention, alongside the strengths and difficulties of applying videoconference-delivered CBT for OCD.

Key learning aims

(1)

Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial

We examined the long-term efficacy of mindfulness-based cognitive therapy (MBCT) compared to a psychoeducation group as an active control condition in patients with obsessive-compulsive disorder (OCD) with residual symptoms of OCD after cognitive behavioral therapy. A total of 125 patients were included in a bicentric, interviewer-blind, randomized, and actively controlled trial and were assigned to either an MBCT group (n = 61) or a psychoeducation group (n = 64). Patients' demographic characteristics and the results from our previous assessments have already been reported (Külz et al., 2019). At the 12-month follow-up the completion rate was 80%. OCD symptoms were reduced from baseline to follow-up assessment with a large effect, but no difference was found between groups. Exploratory analyses showed that a composite score of time occupied by obsessive thoughts, distress associated with obsessive thoughts, and interference due to obsessive thoughts differed between groups in the per-protocol analysis, with a stronger reduction in the MBCT group. At the 12-month follow-up, the two groups showed a similar reduction of symptoms. However, preliminary evidence indicates that MBCT has a superior effect on some aspects of OCD. This should be replicated in future studies.