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Saliani AM, Perdighe C, Zaccari V, Luppino OI, Mancini A, Tenore K, Mancini F. Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention. CLINICAL NEUROPSYCHIATRY 2024; 21:63-78. [PMID: 38559430 PMCID: PMC10979789 DOI: 10.36131/cnfioritieditore2023060104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD). Method DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt. Results DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention. Conclusions Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.
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Affiliation(s)
| | | | - Vittoria Zaccari
- School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Olga Ines Luppino
- School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Italian Academy of Schema Therapy (IAST), Rome, Italy
| | - Alessandra Mancini
- School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Italian Academy of Schema Therapy (IAST), Rome, Italy
| | - Katia Tenore
- School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Italian Academy of Schema Therapy (IAST), Rome, Italy
| | - Francesco Mancini
- School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
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Bey K, Campos-Martin R, Klawohn J, Reuter B, Grützmann R, Riesel A, Wagner M, Ramirez A, Kathmann N. Hypermethylation of the oxytocin receptor gene (OXTR) in obsessive-compulsive disorder: further evidence for a biomarker of disease and treatment response. Epigenetics 2022; 17:642-652. [PMID: 34269138 PMCID: PMC9235899 DOI: 10.1080/15592294.2021.1943864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/05/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) has recently been linked to increased methylation levels in the oxytocin receptor (OXTR) gene, and OXTR hypermethylation has predicted a worse treatment response to cognitive-behavioural therapy (CBT). Furthermore, OCD is associated with childhood trauma and stressful life events, which have both been shown to affect OXTR methylation. Here, we aimed to replicate findings of increased OXTR methylation as a predictor of disease and worse treatment response in an independent sample that received treatment within the public health care system. In addition, we aimed to extend previous findings by examining associations between OXTR hypermethylation, environmental stressors, OCD diagnosis, and treatment response. Methylation levels at two CpGs within OXTR exon III were compared between n = 181 OCD patients and n = 199 healthy controls using linear regression analysis. In a subsample of OCD patients (n = 98) with documented treatment data, we examined associations between methylation and treatment response to CBT. Childhood adversity and stressful life events were assessed using Childhood Trauma Questionnaire and Life Experience Survey, respectively. OCD patients exhibited significant hypermethylation at CpG site cg04523291 compared to controls, and increased methylation was associated with impaired treatment response. Moreover, hypermethylation at cg04523291 was associated with stressful life events in OCD patients, and with childhood adversity in controls. Yet, there were no significant mediation effects. In conclusion, we replicated the association between OXTR hypermethylation and OCD in the largest sample, so far. Furthermore, our findings support the role of OXTR methylation as a promising biomarker for treatment response in OCD.
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Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Rafael Campos-Martin
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, University of Hamburg, Hamburg, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Alfredo Ramirez
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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4
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Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B. Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy. BMC Psychiatry 2022; 22:66. [PMID: 35086513 PMCID: PMC8793233 DOI: 10.1186/s12888-022-03701-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome. METHOD In a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions. RESULTS In a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings. CONCLUSIONS The results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.
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Affiliation(s)
- Björn Elsner
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Tanja Jacobi
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Eva Kischkel
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Daniel Schulze
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
- Department of Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
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5
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Harmelech T, Tendler A, Arikan MK, Çetin HL, Esmeray MT, Ilhan R, Vidrine R, Muir O, MacMillan C, Sinclair R, Shakir S, Kent D, Evangelidis N, Roth Y. Long-term outcomes of a course of deep TMS for treatment-resistant OCD. Brain Stimul 2022; 15:226-228. [PMID: 34982981 DOI: 10.1016/j.brs.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tal Harmelech
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel.
| | - Aron Tendler
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel; Advanced Mental Health Care Inc., 1903 Southern Blvd. Royal Palm Beach, FL, 33411, USA; Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mehmet Kemal Arikan
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Hamide Laçin Çetin
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Muhammed Taha Esmeray
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Reyhan Ilhan
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Ryan Vidrine
- Mindful Health Solutions, 360 Post Street, Suite #500, San Francisco, CA, 94108, USA
| | - Owen Muir
- Brooklyn Minds, 347 Grand St, Brooklyn, NY, 11211, USA
| | | | | | - Saad Shakir
- Silicon Valley TMS, 2039 Forest Ave STE 201, San Jose, CA, 95128, USA
| | - David Kent
- NuMe TMS, 2375 S Cobalt Point Way #102, Meridian, ID, 83642, USA
| | | | - Yiftach Roth
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel; Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Beer Sheva, Israel
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6
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Elsner B, Reuter B, Said M, Linnman C, Kathmann N, Beucke JC. Impaired differential learning of fear versus safety signs in obsessive-compulsive disorder. Psychophysiology 2021; 59:e13956. [PMID: 34658040 DOI: 10.1111/psyp.13956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 01/28/2023]
Abstract
Pavlovian learning mechanisms are of great importance both for models of psychiatric disorders and treatment approaches, but understudied in obsessive-compulsive disorder (OCD). Using an established Pavlovian fear conditioning and reversal procedure, we studied skin conductance responses in 41 patients with OCD and in 32 matched healthy control participants. Within both groups, fear acquisition and reversal effects were evident. When comparing groups, patients showed impaired differential learning of threatening and safe stimuli, consistent with previous research. In contrast to prior findings, differential learning impairments were restricted to fear acquisition, and not observed in the reversal stage of the experiment. As previous and present fear reversal experiments in OCD differed in the use of color coding to facilitate stimulus discrimination, the studies converge to suggest that differential learning of threatening versus safe stimuli is impaired in OCD, but manifests itself differently depending on the difficulty of the association to be learned. When supported by the addition of color, patients with OCD previously appeared to acquire an association early but failed to reverse it according to changed contingencies. In absence of such color coding of stimuli, our data suggest that patients with OCD already show differential learning impairments during fear acquisition, which may relate to findings of altered coping with uncertainty previously observed in OCD. Impaired differential learning of threatening versus safe stimuli should be studied further in OCD, in order to determine whether impairments in differential learning predict treatment outcomes in patients, and whether they are etiologically relevant for OCD.
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Affiliation(s)
- Björn Elsner
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mahboba Said
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clas Linnman
- Spaulding Neuroimaging Lab, Harvard Medical School, Boston, Massachusetts, USA
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan-Carl Beucke
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Institute for Systems Medicine, Department of Medicine, MSH Medical School Hamburg, Hamburg, Germany
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7
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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