Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design

Feasibility and preliminary outcomes of compassion-focused acceptance and commitment therapy delivered via telehealth in a community behavioral health clinic

Introduction

Given the significant roles self-criticism and shame can play in the development and maintenance of psychological disorders, several compassion-based treatments, such as compassion-focused therapy (CFT), have been developed in recent years to address shame-based difficulties across a range of psychopathological conditions. CFT aligns with major tenets of acceptance and commitment therapy (ACT), which has been shown to be effective in treating various clinical disorders. Compassion focused acceptance and commitment therapy (CFACT) merges elements of CFT and ACT.

Method

This study examined the feasibility, acceptability, and preliminary outcomes of a manualized CFACT protocol for transdiagnostic presentations in a community behavioral health clinic through a non-concurrent multiple baseline single-case experimental design. Participants received the therapy over 16-19 weekly sessions. Symptom severity, self-compassion, guilt, shame, attributional styles (detachment and externalization of blame), psychological flexibility, functioning in valued life contexts, and quality of life were assessed across baseline and treatment phases. Ratings of perceived utility and other aspects of interest/receptivity were also collected.

Results

Results indicate strong acceptability and receptivity for CFACT across both participants and clinicians. Training clinicians in CFACT and implementing the treatment over telehealth in a training clinic setting was feasible. Most participants exhibited reliable decreases in symptom distress and psychological inflexibility, and reliable increases in self-compassion. Detachment level increased for most participants. Trajectories of guilt-proneness, shame-proneness, externalization of blame, and quality of life either varied across participants or remained unchanged. Supplemental cross-lagged correlation analyses did not demonstrate predictive associations between variables.

Discussion

While quantitative outcome results were mixed, preliminary evidence suggests CFACT contributes to reduced symptom distress and increased psychological flexibility, self-compassion, and detached attributional style. Limitations and future directions are discussed.

Understanding Self-Criticism: A Systematic Review of Qualitative Approaches

Objective

Self-criticism (SC) is a central transdiagnostic factor in several psychopathological conditions, influencing the development and maintenance of symptomatology. The importance of this construct has stimulated quantitative and qualitative research about it. The main purpose of this systematic review is to highlight which qualitative methods have been used most frequently and which are most suitable for studying SC.

Method

We conducted a systematic search by searching the following databases to identify publications: PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and ERIC (all years up to and including January 2024). We aggregated search terms into two concepts for all databases: "self-criticism" and "qualitative analysis".

Results

After removing duplicates, we screened a total of 852 records, resulting in the identification of 28 full-text articles that we assessed for eligibility. Upon closer examination, there was consensus that 16 of those studies met the inclusion criteria. Data extracted from the included studies revealed the lack of a shared approach regarding qualitative analysis of SC. Some studies employed a top-down coding approach, others used a bottom-up coding approach, and a few combined both methods. Consensual qualitative research and thematic analysis have been used most widely in the field. Furthermore, the data revealed no consensus among researchers on the conceptualization of SC. SC categories identified through qualitative analysis frequently do not align with existing theoretical models, and these categories are rarely re-examined in subsequent studies.

Conclusions

There is a need to test existing theoretical models of SC through qualitative analysis and to develop new models that should be examined with qualitative and quantitative methods in different clinical populations to fully capture the complexity and multidimensionality of SC.

Agomelatine efficacy in treatment resistant obsessive-compulsive disorder: A randomized controlled trial

BACKGROUND

Obsessive-compulsive disorder (OCD) is a prevalent and burdensome mental health condition, often resistant to conventional treatments. Agomelatine (Valdoxan), a compound acting on serotonin and melatonin systems, has shown promise in treating those with treatment-resistant OCD based on anecdotal reports and case studies.

METHODS

A randomized, double-blind controlled trial was conducted with 60 patients diagnosed with treatment-resistant OCD. Participants were randomized into an intervention group (receiving agomelatine 50 mg/day) and a control group (receiving placebo). OCD symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) over a 12-week period.

RESULTS

There were no significant differences in age, gender, or baseline Y-BOCS scores between intervention and control groups. Agomelatine did not demonstrate a significant improvement in OCD symptoms compared to placebo. Adverse events were comparable between groups, and liver enzyme levels remained within the normal range.

CONCLUSION

This study, while not confirming superior efficacy compared to placebo, underscores the need for continued investigation into agomelatine's potential for treating specific subgroups of OCD patients, underscoring the need for more comprehensive and well-controlled trials in the future.

Deontological Guilt Mediates the Effects of Personality on the Symptoms of Romantic Relationship Obsessive Compulsive Disorder (ROCD)

Objective

Relationship obsessive-compulsive disorder (ROCD), a clinical variant of OCD, is associated with personality traits and guilt sensitivity. Previous studies have not investigated whether the guilt associated with ROCD stems from deontological or altruistic morality. The main aim of the present study was to explore the differentiated impact of deontological and altruistic guilt on ROCD symptoms in romantic relationships. The study also aimed to test the mediating role of guilt in the relationships between personality traits and ROCD symptoms.

Method

Through linear regressions and path analysis, we examined the results of an online survey administered to 659 emerging adults, assessing the Big-5 personality traits, ROCD symptoms, and the moral orientation of guilt feelings (deontological/altruistic).

Results

Results revealed the negative influence of agreeableness and emotionality on ROCD symptoms. Moral dirtiness, as a facet of deontological moral orientation, was found to mediate the effects of personality predictors on relationship-centred but not on partner-focused ROCD symptoms, providing support for differential diagnosis.

Conclusions

These findings provide a clearer understanding of the cognitive determinants that sustain ROCD symptoms and offer evidence on associated personality traits. These results may represent a valuable source of knowledge for researchers as well as clinical therapists dealing with ROCD symptoms, couple disorders, and sexual dysfunction.

Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times

The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an evidence-based group treatment that is particularly appropriate for the current global climate.

Study on symptom dimensions and clinical characteristics in patients with obsessive-compulsive disorder

BACKGROUND AND OBJECTIVE

The aim of this study was to explore the symptom dimensions and clinical characteristics of obsessive-compulsive disorder in the context of Chinese culture.

METHODS

In this cross-sectional study, the severity of obsessive-compulsive symptoms, the distribution of symptoms, and symptom scores of 263 patients with obsessive-compulsive disorder were assessed using the Yale-Brown Obsessive-Compulsive Scale and Yale-Brown Obsessive-Compulsive Inventory Symptoms Checklist. System cluster analysis and Pearson analysis were performed to explore the relationships between the main clinical characteristics and symptom dimensions.

RESULTS

Cluster analysis identified four symptom dimensions of obsessive-compulsive disorder: (1) symmetry precision; (2) contamination cleaning; (3) aggression examination; and (4) taboo thinking. The symmetry precision dimension showed an association with years of education. The compulsive score, total Yale-Brown Obsessive Compulsive Scale score, contamination cleaning dimension, and aggression examination dimension had significant relationships. Age, age at onset, obsessive score, and compulsive score had a significant correlation with the taboo-thinking dimension.

CONCLUSION

The symptom dimensions of obsessive-compulsive disorder in China are similar to those in other regions. Each of the four symptom dimensions had distinct clinical characteristics.

A preliminary investigation of the mediating roles of self-compassion and emotion dysregulation in the relationship between maladaptive perfectionism and obsessive-compulsive behaviors

INTRODUCTION

Recent research has highlighted an association between maladaptive perfectionism and obsessive-compulsive disorder (OCD). However, the mechanisms underlying this relationship are not well understood. The primary aim of this preliminary study was to investigate whether self-compassion and emotion dysregulation independently mediated this relationship. The secondary aim was to determine whether serial mediation existed between these factors. Whether these relations held for overall obsessive-compulsive (OC) symptoms, versus distinct dimensions of OCD, was also of interest.

METHOD

Three hundred and ninety-two university students (Mage  = 21.81, SD = 8.01), predominantly female (79.18%), participated in an online questionnaire that included a dimensional measure of OCD. Scales assessing maladaptive perfectionism, self-compassion, emotion dysregulation, and negative emotion states were also included.

RESULTS

Greater maladaptive perfectionism was related to more severe OCD. Emotion dysregulation, but not self-compassion, independently mediated this relationship. A serial mediation relationship was found, in that greater maladaptive perfectionism was associated with lower self-compassion, which was linked to greater emotion dysregulation, and in turn related to more severe OC behaviors. In addition, distinct patterns emerged for separate OC dimensions.

CONCLUSIONS

These findings highlight emotion regulation and self-compassion as potential targets for OCD prevention, especially in individuals with symptoms in the symmetry and unacceptable thoughts dimensions.

Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention

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.

Single-case design meta-analyses in education and psychology: a systematic review of methodology

Meta-analysis is of increasing importance as this quantitative synthesis technique has the potential to summarize a tremendous amount of research evidence, which can help making evidence-based decisions in policy, practice, and theory. This paper examines the single-case meta-analyses within the Education and Psychology fields. The amount of methodological studies related to the meta-analysis of Single-Case Experimental Designs (SCEDs) is increasing rapidly, especially in these fields. This underscores the necessity of a succinct summary to help methodologists identify areas for further development in Education and Psychology research. It also aids applied researchers and research synthesists in discerning when to use meta-analytic techniques for SCED studies based on criteria such as bias, mean squared error, 95% confidence intervals, Type I error rates, and statistical power. Based on the summary of empirical evidence from 18 reports identified through a systematic search procedure, information related to meta-analytic techniques, data generation and analysis models, design conditions, statistical properties, conditions under which the meta-analytic technique is appropriate, and the study purpose(s) were extracted. The results indicate that three-level hierarchical linear modeling is the most empirically validated SCED meta-analytic technique, and parameter bias is the most prominent statistical property investigated. A large number of primary studies (more than 30) and at least 20 measurement occasions per participant are recommended for usage of SCED meta-analysis in Education and Psychology fields.

Obsessive-compulsive existential type: a dialectical-phenomenological approach

The clinical presentation of obsessive-compulsive patients is characterized by unwanted, intrusive, nonsensical, self-related, and recurrent ideas, thoughts, images, or impulses associated with active compulsive compensations. Under the operational diagnostic criteria adopted by the biological- and cognitive-oriented neopositivist medical paradigm, it is known as "obsessive-compulsive disorder." However, this paradigm has been criticized for its controversial assumptions, limited methodologies, theoretic biases, and inconsistency in producing practical outcomes. To bypass some of these issues, we propose a complementary approach that draws on and further develops existing psychopathological studies of the obsessive-compulsive anthropological condition based on dialectical phenomenological psychopathology. As such, we refer to the global clinical configuration as the "obsessive-compulsive existential type." Our theoretical inspiration comes from the classical phenomenological work on obsessions undertaken by Straus and Gebsattel, which identified the negative transformation of the obsessive-compulsive life-world or the endogenous emergence of the anti-eidos (diluting existential force). We then propose to broaden the concept of anti-eidos, especially in its dialectical correlation with eidos (unifying existential force), representing the existential dialectic between transformation and permanence. Next, we detail the dynamics of anthropological disproportions in obsessive-compulsive existential type, essentially the supremacy of the anti-eidos over the eidos. This primary imbalance modifies the obsessive-compulsive existential structure, consisting of polymorphic temporality; weakened intentionality; maladjusted calibration of distance with the world and others; an integral, isolated, besieged self with dwindling self-agency, and tense and over-protecting embodiment. We also analyze compensatory hyperreflexivity and compulsive rituals as expressions of structural counterbalancing designed to contain the primary structural disproportions and derangements. The heterogeneous obsessive-compulsive clinical manifestations are the complex result of the primary structural alteration and subsequent phenomenological compensations. They tend to be variable in temporal span and rarely assume a fixed form, hindering diagnosis. We correlate structural frameworks with multiple clinical examples. Finally, we raise some insights on how our study may contribute to scientific research and therapeutic proposals.

The association between OCD and Shame: A systematic review and meta-analysis

BACKGROUND

Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.

OBJECTIVES

Our review systematically examines the association of shame with OCD and unacceptable thoughts.

METHODS

The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.

RESULTS

The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509].

LIMITATIONS

Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.

CONCLUSIONS

Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.

The power of compassion in group psycotherapy

Research has repeatedly demonstrated that individual and group psychotherapy are equally effective. Compassion-focused therapy (CFT) has been shown to be an effective approach to treating individuals with a wide range of presenting mental health concerns. In this study, we discuss the basic tenets of CFT and introduce a 12-module CFT group psychotherapy approach for college counseling centers. We use a clinical vignette to provide an example of how psychotherapists may implement this approach. We then discuss clinical applications, including strengths and limitations of this approach.

The compassionate love for humanity scale (CLS-H-SF): psychometric properties of the Persian version

Compassionate love is beneficial in a variety of domains, including in education, health, and law, as well as in people’s personal lives. The topic of compassionate love has therefore attracted growing interest from researchers interested in its psychological and social dimensions. Given the importance of compassion to the education and health sectors, and the expansion of these sectors in Iran, this paper aims to provide Persian (Farsi) speaking practitioners and researchers with an effective instrument for measuring compassion. As such, the authors have translated the compassionate love for humanity scale-short form (CLS-H-SF) into the Persian language, and assessed the psychometric properties of this instrument among a sample of the Iranian population. A sample of 827 adults (49.9% women and 51.1% men) completed the Persian version of the CLS-H-SF through an online survey. Concurrent validity was assessed using the Persian versions of the positive and negative affect scale, self-esteem scale, and satisfaction with life scale. The CLS-H-SF positively correlated with positive affect, self-esteem and life satisfaction, and negatively correlated with negative affect. These findings indicate acceptable concurrent validity for the CLS-H-SF. Cronbach’s alpha for the scale was 0.88, indicating good internal consistency between items. A confirmatory factor analysis supported a one-factor model same as the English version of the CLS-H-SF. The findings of this study showed the Persian version of CLS-H-SF had acceptable validity and reliability in assessing compassionate love for humanity in Iranian adults.