Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?

Effectiveness of add-on yoga in reducing the symptoms of obsessive compulsive disorder (OCD): A randomized controlled trial

BACKGROUND

The standard treatments for Obsessive Compulsive Disorder (OCD) have been pharmacological and psychotherapeutic, with preliminary evidence for yoga as an intervention.

AIM

To test the short-term effects of a validated yoga intervention as an adjunct to medication in patients with OCD.

SETTINGS AND DESIGN

The study included patients diagnosed with OCD attending a tertiary psychiatry hospital in south India using a Randomized Controlled Trial (RCT) design.

METHODS

The study included 50 patients with OCD who were randomized into yoga group (n=25) and waitlist control group (n=25). All patients continued medication during the period of study. 42 subjects (Yoga=20, waitlist control=22) completed the study period of 4 weeks. Patients in the yoga group received 10 supervised sessions of a validated yoga module for OCD and continued home practice for next 20 days. Patients were rated on the Yale Brown Obsessive Compulsive Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Brown Assessment of Beliefs Scale at baseline and end of 4th week by raters who were blind to group status. For qualitative assessment, subjects were interviewed individually till data saturation was reached (n=11).

RESULTS

Patients randomized to yoga showed significant improvement in Obsessions (p-<0.001) (η2-1.3), Compulsions (p-0.007) (η2-0.8), Anxiety (p-0.002) (η2-1.0) and Depression (0.003) (η2-0.9) scores compared to patients in the waitlist control group. Qualitative results showed that yoga was efficacious in improving physical, mental, and overall health.

CONCLUSION

Yoga-based intervention as an adjunct to medication was effective in reducing symptoms in outpatients with OCD over 4 weeks.

Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled trial

BACKGROUND

Adherence to internet-based cognitive-behavioral therapy (iCBT) is often low, possibly reducing its potential. The current study set out to test whether adherence and effects of unguided iCBT for obsessive-compulsive disorder (OCD) could be improved by varying the degree of autonomy in which modules are completed (free choice vs. fixed order).

METHODS

We randomized 151 individuals with OCD to either an unguided iCBT with a fixed (iCBTfixed) or a free-choice (iCBTfree+) order of the modules. We assessed participants at baseline (t0), eight weeks (t1), and 16 weeks (t2). Primary outcomes were adherence (utilization time, modules completed) and change in OCD severity (Y-BOCS). Secondary outcomes included depression, self-esteem, and treatment satisfaction. We calculated intent-to-treat (ITT) and complete case (CC) analyses.

RESULTS

Analyses showed that both iCBT programs significantly reduced OCD severity. While groups did not differ on the ITT analyses, for the CC analyses, a greater improvement was found in the iCBTfixed in comparison to the iCBTfree+ group regarding OCD severity and quality of life, with medium effect sizes from t0 to t1 (ηp2 = 0.067-0.077). Time of utilization and number of modules completed did not differ between groups.

LIMITATIONS

No placebo control group, short follow-up period, self-report assessment.

CONCLUSIONS

iCBT is effective in improving OCD. Despite similar adherence in the fixed versus the free-choice module order, the study offers tentative evidence that a fixed order of content is associated with better effects. More research on the effects of adherence on outcome is necessary.