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Mao L, Hu M, Luo L, Wu Y, Lu Z, Zou J. The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:973838. [PMID: 36186855 PMCID: PMC9520065 DOI: 10.3389/fpsyt.2022.973838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD). METHODS PubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data. RESULTS A total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = -6.60, 95% CI: -8.35 to -4.84, P < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: -0.87 to 1.17, P = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = -7.14, 95% CI: -9.17 to -5.10, P < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = -0.08, 95% CI: -0.31 to 0.15, P = 0.50). ERP combined with drug improved patients' depression levels significantly better than providing drug alone (SMD = -0.40, 95% CI: -0.68 to -0.11, P = 0.006). CONCLUSION Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.
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Affiliation(s)
- Lingyun Mao
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maorong Hu
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lan Luo
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yunhong Wu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zihang Lu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingzhi Zou
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Vaccaro LD, Jones MK, Menzies RG, Wootton BM. The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Lisa D. Vaccaro
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ross G. Menzies
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Bethany M. Wootton
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia,
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3
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Rupp C, Jürgens C, Doebler P, Andor F, Buhlmann U. A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder. PLoS One 2019; 14:e0213895. [PMID: 30893353 PMCID: PMC6426247 DOI: 10.1371/journal.pone.0213895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions. Design We conducted a randomized waitlist-controlled trial. n = 43 participants were randomly assigned to either DM or CR. Out of those participants, n = 21 participants had been previously assigned to a two-week waitlist condition. Materials and methods In both conditions, treatment comprised four double sessions within two weeks. Assessment took place at baseline (Pre1), after treatment (Post) and four weeks after the end of treatment (FU). There was a second baseline assessment (Pre2) in the waitlist group. Independent evaluators were blinded concerning the active condition. Adherence and competence ratings for the two therapists were obtained from an independent rater. Results 40 patients completed the treatment. Two patients dropped out because of exacerbated depression. There were no further adverse events. Both CR and DM were shown to be superior to waitlist and equally effective at reducing OCD symptoms from pre to post assessment as measured with the Y-BOCS (CR: d = 1.67, DM: d = 1.55). In each of the two treatment conditions, eight patients (40%) exhibited a clinical significant change at post assessment. Conclusions The results of this clinical trial suggest the potential efficacy of DM as a stand-alone intervention for OCD, however, our findings need to be interpreted with caution. Results indicate that both CR and DM should be considered as possible alternative treatments for OCD, whereas the working mechanisms of DM have yet to be elucidated.
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Affiliation(s)
- Christian Rupp
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Charlotte Jürgens
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Fabian Andor
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- * E-mail:
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Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for OCD: A Patient-Level Mega-Analysis of Eight Sites. Behav Ther 2019; 50:165-176. [PMID: 30661557 DOI: 10.1016/j.beth.2018.04.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/22/2022]
Abstract
Cognitive (CT) and behavioral treatments (BT) for OCD are efficacious separately and in combination. Tailoring treatment to patient-level predictors and moderators of outcome has the potential to improve outcomes. The present study combined data from eight treatment clinics to examine the benefits of BT (n = 125), CT (n = 108), and CBT (n = 126), and study predictors across all treatments and moderators of outcome by treatment type. All three methods led to large benefits for OCD and depression symptoms. Residual gain scores for OCD symptoms were marginally smaller for BT compared to treatments containing CT. For depression, significantly more gains were evident for CBT than BT, and CT did not differ from either. Significantly fewer BT participants (36%) achieved clinically significant improvement compared to CT (56%), and this was marginally evident for CBT (48%). For all treatments combined, no predictors were identified in residual gain analyses, but clinically improved patients had lower baseline depression and stronger beliefs about responsibility/threat and importance/control of thoughts. Moderator analyses indicated that higher baseline scores on depression adversely affected outcomes for BT but not CT or CBT, and lower OCD severity and more education were associated with positive outcomes for CT only. A trend was evident for higher responsibility/threat beliefs to moderate clinical improvement outcomes for those receiving cognitive (CT and CBT), but not behavioral (BT) treatment. Medication status and comorbidity did not predict or moderate outcomes. Findings are discussed in light of models underlying behavioral and cognitive treatments for OCD.
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Ergang BC, Molle RD, Reis RS, Rodrigues DM, Mucellini AB, Toazza R, Cunha ACDA, Silveira PP, Manfro GG, Machado TD. Perceived maternal care is associated with emotional eating in young adults. Physiol Behav 2018; 201:91-94. [PMID: 30578893 DOI: 10.1016/j.physbeh.2018.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Early life adversity, including the perception of poor quality of maternal care, is associated with long-term metabolic and psychosocial consequences. The negative quality of mother/child relationship is associated with emotional overeating in young children, which is defined by eating in response to emotional arousal states such as fear, anger or anxiety. However, it is not known if this association persists through adolescence. Therefore, we aimed at verifying if maternal care during infancy can influence emotional eating in young adults. METHODS Seventy-five adolescents, residents of Porto Alegre, who participated in the PROTAIA Program (anxiety disorder in childhood and adolescence program), answered the Parental Bonding Instrument (PBI - assessment of perceived maternal care), and the Dutch Eating Behavior Questionnaire (DEBQ). Regression analysis models were built to predict Emotional Eating, a domain of the DEBQ, using maternal care, gender, and anxiety as independent variables. RESULTS The model was statistically significant when adjusted for potential confounders (r2 = 0.272; p < 0.0001). Emotional eating was significantly predicted by levels of maternal care, anxiety and gender (beta = -0.316; p = 0.006). CONCLUSION The results demonstrated a negative association between the quality of maternal care and emotional eating in young adults, suggesting that the early environment could be involved on the development of eating disorders or on the differential eating behavior in adolescents with emotional disorders.
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Affiliation(s)
- Bárbara Cristina Ergang
- Graduação em Nutrição, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, CEP 90035-003,Porto Alegre, RS, Brazil.
| | - Roberta Dalle Molle
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Largo Eduardo Zaccaro Faraco, CEP 90035-003 Porto Alegre, RS, Brazil
| | - Roberta Sena Reis
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Largo Eduardo Zaccaro Faraco, CEP 90035-003 Porto Alegre, RS, Brazil
| | - Danitsa Marcos Rodrigues
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil, Rua Sarmento Leite, 500, Sala 107 (Campus Centro), CEP 90046-900 - Porto Alegre, RS, Brazil
| | - Amanda Brondani Mucellini
- Programa de Pós-Graduação em Ciências Médicas: Psiquiatria, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, Santana, CEP 90035-003 Porto Alegre, RS, Brazil
| | - Rudinéia Toazza
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil, Rua Sarmento Leite, 500, Sala 107 (Campus Centro), CEP 90046-900 - Porto Alegre, RS, Brazil
| | - Ana Carla de Araújo Cunha
- Graduação em Nutrição, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, CEP 90035-003,Porto Alegre, RS, Brazil
| | - Patrícia Pelufo Silveira
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Largo Eduardo Zaccaro Faraco, CEP 90035-003 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil, Rua Sarmento Leite, 500, Sala 107 (Campus Centro), CEP 90046-900 - Porto Alegre, RS, Brazil
| | - Gisele Gus Manfro
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil, Rua Sarmento Leite, 500, Sala 107 (Campus Centro), CEP 90046-900 - Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Médicas: Psiquiatria, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, Santana, CEP 90035-003 Porto Alegre, RS, Brazil
| | - Tania Diniz Machado
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Largo Eduardo Zaccaro Faraco, CEP 90035-003 Porto Alegre, RS, Brazil
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Rosser BA. Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9964-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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7
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Kaplan DM, Palitsky R, Carey AL, Crane TE, Havens CM, Medrano MR, Reznik SJ, Sbarra DA, O'Connor MF. Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. J Clin Psychol 2018; 74:1126-1136. [DOI: 10.1002/jclp.22585] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023]
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8
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Diedrich A, Sckopke P, Schwartz C, Schlegl S, Osen B, Stierle C, Voderholzer U. Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study. BMC Psychiatry 2016; 16:220. [PMID: 27388205 PMCID: PMC4937602 DOI: 10.1186/s12888-016-0914-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/08/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. METHODS Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. RESULTS Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. CONCLUSIONS Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.
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Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336, Munich, Germany.
| | - Philipp Sckopke
- Department of Psychology, University of Munich (LMU), Leopoldstr. 13, 80802 Munich, Germany
| | - Caroline Schwartz
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336 Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336 Munich, Germany
| | - Bernhard Osen
- Schön Clinic Bad Bramstedt, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Christian Stierle
- Schön Clinic Bad Bramstedt, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany ,Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
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Amir N, Kuckertz JM, Najmi S, Conley SL. Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD using Cognitive Bias Modification. COGNITIVE THERAPY AND RESEARCH 2015; 39:424-440. [PMID: 26366021 DOI: 10.1007/s10608-015-9675-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Exposure and Response Prevention (ERP) is the most effective treatment for OCD but it is not accessible to most patients. Attempts to increase the accessibility of ERP via self-directed ERP (sERP) programs such as computerized delivery and bibliotherapy have met with noncompliance, presumably because patients find the exposure exercises unacceptable. Previous research suggests that Cognitive Bias Modification (CBM) interventions may help individuals approach feared situations. The goal of the current study was to test the efficacy of a treatment program for OCD that integrates sERP with CBM. Twenty-two individuals meeting diagnostic criteria for OCD enrolled in our 7-week treatment program. Results suggest that sERP with CBM led to significant reduction of OCD symptoms and functional impairment. Indeed, the magnitude of the effect of this novel treatment, that requires only an initial session with a clinician trained in ERP for OCD, was comparable to that of the gold standard clinician-administered ERP. Moreover, preliminary evidence suggests that CBM interventions targeting interpretation bias may be most effective, whereas those targeting attention and working memory bias may not be so.
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Affiliation(s)
- Nader Amir
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Jennie M Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Sadia Najmi
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Sara L Conley
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
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10
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The evolution of behaviour therapy and cognitive behaviour therapy. Behav Res Ther 2015; 64:1-8. [DOI: 10.1016/j.brat.2014.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 11/22/2022]
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Thiel N, Tuschen-Caffier B, Herbst N, Külz AK, Nissen C, Hertenstein E, Gross E, Voderholzer U. The prediction of treatment outcomes by early maladaptive schemas and schema modes in obsessive-compulsive disorder. BMC Psychiatry 2014; 14:362. [PMID: 25540106 PMCID: PMC4324412 DOI: 10.1186/s12888-014-0362-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Higher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls. This study examines the relationship of EMS and schema modes to OC symptom severity and the predictive value of EMS and schema modes on treatment outcome in inpatients receiving Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). The main assumption was a negative association between the EMS of the domain 'disconnection' and dysfunctional coping and parent schema modes and the treatment outcome. METHODS EMS, schema modes, depression and traumatic childhood experiences were measured in 70 patients with OCD. To analyze the predictors, two regression analyses were conducted considering multiple variables, such as depression, as covariates. RESULTS Regression analyses demonstrated that higher scores on the EMS named failure and emotional inhibition and depressive symptom severity at pretreatment were significantly related to poor outcome and explained a high percentage of the variance in OC symptoms at posttreatment. No influence on the treatment outcome was observed for schema modes, other EMS or other covariates. CONCLUSIONS The results support the approach to extend the CBT with ERP treatment with therapeutic elements focusing on maladaptive schemas, particularly in non-responders.
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Affiliation(s)
- Nicola Thiel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany.
| | - Nirmal Herbst
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Anne Katrin Külz
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Elisabeth Hertenstein
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Ellen Gross
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany.
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany.
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Wilhelm S, Berman NC, Keshaviah A, Schwartz RA, Steketee G. Mechanisms of change in cognitive therapy for obsessive compulsive disorder: role of maladaptive beliefs and schemas. Behav Res Ther 2014; 65:5-10. [PMID: 25544403 DOI: 10.1016/j.brat.2014.12.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/12/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.
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Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States.
| | - Noah C Berman
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Aparna Keshaviah
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Rachel A Schwartz
- Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States
| | - Gail Steketee
- Boston University School of Social Work, 264Bay State Rd., Boston, MA 02215, United States
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Chosak A, Marques L, Greenberg JL, Jenike E, Dougherty DD, Wilhelm S. Body dysmorphic disorder and obsessive–compulsive disorder: similarities, differences and the classification debate. Expert Rev Neurother 2014; 8:1209-18. [DOI: 10.1586/14737175.8.8.1209] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hans E, Hiller W. A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders. Clin Psychol Rev 2013; 33:954-64. [DOI: 10.1016/j.cpr.2013.07.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9576-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. J Psychiatr Res 2013; 47:33-41. [PMID: 22999486 DOI: 10.1016/j.jpsychires.2012.08.020] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/13/2012] [Accepted: 08/16/2012] [Indexed: 11/23/2022]
Abstract
The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) as well as potential moderators that may be associated with outcome. A literature search revealed sixteen randomized-controlled trials (RCTs) with a total sample size of 756 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 1.39) and at follow-up (Hedges's g = 0.43). Subsequent analyses revealed few moderators of CBT efficacy. Neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size. Similarly, effect size did not vary as a function of 'type' of CBT, treatment format, treatment integrity assessment, blind assessment, age of onset, duration of symptoms, percentage of females, number of sessions, or percent comorbidity. However, active treatments showed smaller effect sizes when compared to placebo controls than when compared to waitlist controls. Effect sizes were also smaller for adult RCTs than child RCTs. Likewise, older age was associated with smaller effect sizes. However, an association between age and effect size was not observed when examining child and adult samples separately. This review indicates that while CBT is efficacious in the treatment of OCD, more research is needed to identify processes that may predict more favorable treatment responses.
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Yap K, Mogan C, Kyrios M. Obsessive-compulsive disorder and comorbid depression: the role of OCD-related and non-specific factors. J Anxiety Disord 2012; 26:565-73. [PMID: 22495108 DOI: 10.1016/j.janxdis.2012.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/17/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
Although comorbid depression is a predictor of poor treatment response in obsessive-compulsive disorder (OCD), there is limited understanding of factors that contribute to depression severity in OCD. The current study examines the influence of OCD-related factors (autogenous obsessions and obsessional beliefs) and non-specific factors (avoidance and anxiety) on depression severity in a sample of OCD patients. There were 56 participants with only OCD and 46 with OCD and comorbid depression. Self-report questionnaires measuring depression, OCD-related factors, and non-specific factors were completed. Although there were no significant differences between the two groups on these variables, depression severity was positively correlated with anxiety, avoidance, obsessional beliefs, and autogenous obsessions in the whole sample. When entered into a multiple regression model to predict depression severity, these factors accounted for 51% of the variance. While OCD-related factors remained significant predictors after controlling for non-specific factors, the non-specific factors made the most significant contributions to the model. Our findings suggest that in addition to dealing with autogenous obsessions, addressing anxiety and avoidance might lead to improvements in the treatment of OCD with comorbid depression.
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Affiliation(s)
- Keong Yap
- School of Health Sciences, RMIT University, Plenty Road, Bundoora, Victoria 3083, Australia.
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Stewart SE, Hezel D, Stachon AC. Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder. Drugs 2012; 72:881-93. [DOI: 10.2165/11632860-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Borges CP, Meyer E, Ferrão YA, Souza FP, Sousa MB, Cordioli AV. Cognitive-behavioral group therapy versus sertraline for obsessive-compulsive disorder: five-year follow-up. PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:249-50. [PMID: 21540627 DOI: 10.1159/000322028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 10/06/2010] [Indexed: 11/19/2022]
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Steketee G, Siev J, Fama JM, Keshaviah A, Chosak A, Wilhelm S. Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder. Depress Anxiety 2011; 28:333-41. [PMID: 21308884 PMCID: PMC3076701 DOI: 10.1002/da.20785] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/20/2010] [Accepted: 11/06/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The present study sought to identify predictors of outcome for a comprehensive cognitive therapy (CT) developed for patients with obsessive-compulsive disorder (OCD). METHODS Treatment was delivered over 22 sessions and included standard CT methods, as well as specific strategies designed for subtypes of OCD including religious, sexual, and other obsessions. This study of 39 participants assigned to CT examined predictors of outcomes assessed on the Yale-Brown Obsessive Compulsive Scale. A variety of baseline symptom variables were examined as well as treatment expectancy and motivation. RESULTS Findings indicated that participants who perceived themselves as having more severe OCD at baseline remained in treatment but more severe symptoms were marginally associated with worse outcome for those who completed therapy. Depressed and anxious mood did not predict post-test outcome, but more Axis I comorbid diagnoses (mainly major depression and anxiety disorders), predicted more improvement, as did the presence of sexual (but not religious) OCD symptoms, and stronger motivation (but not expectancy). A small rebound in OCD symptoms at 1-year follow-up was significantly predicted by higher scores on personality traits, especially for schizotypal (but not obsessive-compulsive personality) traits. CONCLUSIONS Longer treatment may be needed for those with more severe symptoms at the outset. CT may have positive effects not only on OCD symptoms but also on comorbid depressive and anxious disorders and associated underlying core beliefs. Findings are discussed in light of study limitations and research on other predictors.
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Affiliation(s)
- Gail Steketee
- Boston University Schoolof Social Work, 264 Bay State Road, Boston, MA 02215, USA.
| | - Jedidiah Siev
- Massachusetts General Hospital and Harvard Medical School
| | - Jeanne M. Fama
- Massachusetts General Hospital and Harvard Medical School
| | | | - Anne Chosak
- Massachusetts General Hospital and Harvard Medical School
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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Kyrios M. Introduction to the Special Section: Cognitive-Behavioral and Neursscientific Approaches to Obsessive-Compulsive and Related Phenomena: Why the Need for an Interface? Int J Cogn Ther 2011. [DOI: 10.1521/ijct.2011.4.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Believe in yourself: Manipulating beliefs about memory causes checking. Behav Res Ther 2011; 49:42-9. [DOI: 10.1016/j.brat.2010.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 09/30/2010] [Accepted: 10/02/2010] [Indexed: 11/19/2022]
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Belloch A, Cabedo E, Carrió C, Larsson C. Cognitive therapy for autogenous and reactive obsessions: clinical and cognitive outcomes at post-treatment and 1-year follow-up. J Anxiety Disord 2010; 24:573-80. [PMID: 20418053 DOI: 10.1016/j.janxdis.2010.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 03/25/2010] [Accepted: 03/25/2010] [Indexed: 11/26/2022]
Abstract
This study provides data about the differential effectiveness of cognitive therapy (CT) for obsessive-compulsive disorder (OCD) symptom presentation. Two OCD manifestations, autogenous and reactive, are considered. Seventy OCD patients started CT; 81.40% completed it and 72.85% were available 1 year later. Fifteen of the 57 treatment completers had autogenous obsessions, whereas 33 had reactive obsessions. Nine patients had both obsession modalities. Reactive patients were more severe, as they scored higher on thought suppression and on the dysfunctional beliefs of intolerance to uncertainty and perfectionism. Autogenous patients scored higher on the over-importance of thoughts beliefs. Although CT was effective in reducing OCD severity and the ascription to dysfunctional beliefs and neutralizing strategies in both the autogenous and the reactive patients, a significantly better outcome was observed for the autogenous patients, both at post-treatment (with 73.33% recovering versus 33.33% for reactives) and 1 year later.
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Affiliation(s)
- Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive Disorder, Facultad de Psicologia, University of Valencia, Valencia, Spain.
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Riccardi CJ, Timpano KR, Schmidt NB. A Case Study Perspective on the Importance of Motivation in the Treatment of Obsessive Compulsive Disorder. Clin Case Stud 2010. [DOI: 10.1177/1534650110376960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Up until three decades ago, obsessive-compulsive disorder (OCD) was deemed treatment resistant—an incurable and chronic disease. However, advent of specific behavioral techniques and new pharmacological agents (serotonin reuptake inhibitors) has altered this course and brought effective relief for many OCD patients. Nonetheless, a substantial number of individuals with OCD are treatment resistant and an even greater number refuse treatment or drop out prematurely. The cognitive-behavioral treatment of a 39-year-old male with OCD is described in this case study. Motivational interviewing (MI) techniques were integrated into treatment to increase adherence, particularly exposure exercises. Frequency and duration of compulsive behaviors were measured over the course of treatment and standard assessment measures were used to assess the severity of OCD symptoms. At posttreatment and follow-up a clinically significant improvement was demonstrated for OCD symptoms. Implications of these data are reviewed, and recommendations about inclusion of MI techniques for clinicians who intend on treating OCD are provided.
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Learning the futility of the thought suppression enterprise in normal experience and in obsessive compulsive disorder. Behav Cogn Psychother 2009; 38:1-14. [PMID: 19852877 DOI: 10.1017/s1352465809990439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The belief that we can control our thoughts is not inevitably adaptive, particularly when it fuels mental control activities that have ironic unintended consequences. The conviction that the mind can and should be controlled can prompt people to suppress unwanted thoughts, and so can set the stage for the intrusive return of those very thoughts. An important question is whether or not these beliefs about the control of thoughts can be reduced experimentally. One possibility is that behavioral experiments aimed at revealing the ironic return of suppressed thoughts might create a lesson that could reduce unrealistic beliefs about the control of thoughts. AIMS The present research assessed the influence of the thought suppression demonstration on beliefs about the control of thoughts in a non-clinical sample, and among individuals with obsessive-compulsive disorder (OCD). METHOD In Study 1, we assessed the effect of the thought suppression demonstration on beliefs about the control of thoughts among low and high obsessive individuals in the non-clinical population (N = 62). In Study 2, we conducted a similar study with individuals with OCD (N = 29). RESULTS Results suggest that high obsessive individuals in the non-clinical population are able to learn the futility of suppression through the thought suppression demonstration and to alter their faulty beliefs about the control of thoughts; however, for individuals with OCD, the demonstration may be insufficient for altering underlying beliefs. CONCLUSIONS For individuals with OCD, the connection between suppressing a neutral thought in the suppression demonstration and suppressing a personally relevant obsession may need to be stated explicitly in order to affect their obsessive beliefs.
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Abstract
Cognitive-behavioral therapy (CBT) with exposure and response prevention is a first-line intervention for adult and childhood obsessive-compulsive disorder. Methodologically rigorous controlled trials have suggested that benefits from CBT exceed those from placebo and attention-control conditions and have similar or greater efficacy than serotonergic monotherapy. This article reviews the nature of CBT and associated outcome data, highlighting recent empiric findings in the treatment literature.
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Emotional Schemas and Self-Help: Homework Compliance and Obsessive-Compulsive Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2007. [DOI: 10.1016/j.cbpra.2006.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Julien D, O'Connor KP, Aardema F. Intrusive thoughts, obsessions, and appraisals in obsessive–compulsive disorder: A critical review. Clin Psychol Rev 2007; 27:366-83. [PMID: 17240502 DOI: 10.1016/j.cpr.2006.12.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/17/2006] [Accepted: 12/01/2006] [Indexed: 11/28/2022]
Abstract
This article reviews empirical findings on two key premises of the appraisal model of obsessive-compulsive disorder (OCD): (a) non-clinical populations experience intrusive thoughts (ITs) that are similar in form and in content to obsessions; and (b) ITs develop into obsessions because they are appraised according to dysfunctional beliefs. There is support for the universality of ITs. However, the samples used are not representative of the general population. IT measures do not relate systematically or exclusively to OCD symptom measures, and are not specific enough to exclude other types of intrusive thoughts such as negative automatic thoughts or worries, nor are they representative of all types of obsessions. When general distress is controlled, there is so far no evidence that participants with OCD endorse obsessive belief domains more strongly than anxious participants, and inconclusive evidence that OCD and non-clinical samples differ on the belief domains. Some OCD symptom subtypes are associated with belief domains. Currently, there is no coherent model to offer strong predictions about the specificity of the empirically derived belief domains in OCD symptom subtypes. Cognitive therapy based on the appraisal model is an effective treatment for OCD, although it does not add to the treatment efficacy of behaviour therapy. It is unclear how appraisals turn ITs into obsessions. Implications for future research are discussed.
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Affiliation(s)
- Dominic Julien
- Centre de recherche Fernand-Seguin, Université de Montréal, Montreal, Quebec, Canada H1N 3V2.
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Sookman D, Steketee G. Directions in Specialized Cognitive Behavior Therapy for Resistant Obsessive-Compulsive Disorder: Theory and Practice of Two Approaches. COGNITIVE AND BEHAVIORAL PRACTICE 2007. [DOI: 10.1016/j.cbpra.2006.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Neziroglu F, Henricksen J, Yaryura-Tobias JA. Psychotherapy of obsessive-compulsive disorder and spectrum: established facts and advances, 1995-2005. Psychiatr Clin North Am 2006; 29:585-604. [PMID: 16650724 DOI: 10.1016/j.psc.2006.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dropout rates and refractory cases persist, for reasons that remain unexplained. There are few predictor variables and few innovative approaches to deal with them. New treatment approaches must be developed to improve treatment response even for the responders. Studies show that symptoms are reduced minimally (30% 50%). No new ways of dealing with treatment-refractory cases have been developed. Studies now include more co-morbid cases, however, and their inclusion may account for some of the lack of progress in improvement rates. It needs to be seen whether patients who have one or more comorbid conditions do as well as patients who do not have comorbidity and whether the number or type of comorbid disorders accounts for treatment response. Perhaps better results would be seen with pure OCD cases. Certainly results now are more generalizable to clinical practice. Now it is important to look for alternative treatment approaches and to apply cognitive therapy to more specific problems. Cognitive therapy seems to be helpful with the disorders of the obsessive-compulsive spectrum. The attrition rate is lower when cognitive therapy is used in the treatment of hypochondriasis, and cognitive therapy also is helpful in reducing OVI , which is more severe in body dysmorphic disorder and hypochondriasis. The role of cognitive therapy in OVI needs further exploration.
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Affiliation(s)
- Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Great Neck, NY 11021, USA.
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