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Varinelli A, Caricasole V, Pellegrini L, Hall N, Garg K, Mpavaenda D, Dell'Osso B, Albert U, Fineberg NA. Functional interventions as augmentation strategies for obsessive-compulsive disorder (OCD): scoping review and expert survey from the international college of obsessive-compulsive spectrum disorders (ICOCS). Int J Psychiatry Clin Pract 2022; 26:92-107. [PMID: 33502269 DOI: 10.1080/13651501.2021.1872646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) commonly exhibit a range of functional difficulties, presumed linked to neurocognitive changes. Evidence-based first-line treatments have limited effect on improving these cognitive-functional problems. Candidate interventions could be used to augment evidence-based treatments by the multi-professional mental health team. METHODS A scoping review was performed to identify any intervention with at least one peer-reviewed report of clinical improvement in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13). Next, an online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders was conducted. RESULTS Forty-four studies were identified reporting a positive outcome for 27 different kinds of intervention. Twenty-six experts from 12 different countries, including at least one expert from each continent, completed the opinion survey. Five interventions were identified as 'highly promising', none of which was moderated by rater-related factors, suggesting global applicability. CONCLUSION Patients with OCD may benefit from a detailed functional assessment, to identify areas of unmet need. A variety of interventions show theoretical promise for treating the complex functional difficulties in OCD as adjuncts to first-line treatments, but the published evidence is weak. Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.HighlightsFunctional-cognitive problems are common in patients with OCD.First-line evidence-based treatments have limited effect on these functionalcognitive difficulties.In our scoping review we found 44 studies reporting of improved clinical outcomes in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13).An online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) was conducted and identified five interventions as "highly promising" candidate treatments for functional-cognitive problems in OCD.Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.
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Affiliation(s)
- Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Davis Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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- International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) Expert Survey Workgroup: Michael Van Ameringen (Canada), Leonardo Fontenelle (Brazil), Giacomo Grassi (Italy), Jamie Feusner (US), Lior Carmi (Israel), Edna Grunblatt (Switzerland), Susanne Walitza (Switzerland), Christine Lochner (South Africa), Carolyn Rodriguez (US), Alexander Bystritsky (US), Maria Ceica Rosario (US), Peter van Roessel (US), Dan Geller (US), Eric Hollander (US), Humberto Nicolini (Mexico), Joseph Zohar (Israel), José Menchón (Spain)
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Reid JE, Laws KR, Drummond L, Vismara M, Grancini B, Mpavaenda D, Fineberg NA. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry 2021; 106:152223. [PMID: 33618297 DOI: 10.1016/j.comppsych.2021.152223] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT), incorporating exposure and response prevention (ERP) is widely recognised as the psychological treatment of choice for obsessive-compulsive disorder (OCD). Uncertainty remains however about the magnitude of the effect of CBT with ERP and the impact of moderating factors in patients with OCD. METHOD This systematic review and meta-analysis assessed randomised-controlled trials of CBT with ERP in patients of all ages with OCD. The study was preregistered in PROSPERO (CRD42019122311). The primary outcome was end-of-trial OCD symptom scores. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were examined. Additional exploratory analyses assessed the effects of treatment fidelity and impact of researcher allegiance. RESULTS Thirty-six studies were included, involving 2020 patients (537 children/adolescents and 1483 adults) with 1005 assigned to CBT with ERP and 1015 to control conditions. When compared against all control conditions, a large pooled effect size (ES) emerged in favour of CBT with ERP (g = 0.74: 95% CI = 0.51 to 0.97 k = 36), which appeared to diminish with increasing age. While CBT with ERP was more effective than psychological placebo (g = 1.13 95% CI 0.71 to 1.55, k = 10), it was no more effective than other active forms of psychological therapy (g = -0.05: 95% CI -0.27 to 0.16, k = 8). Similarly, whereas CBT with ERP was significantly superior when compared to all forms of pharmacological treatment (g = 0.36: 95% CI 0.7 to 0.64, k = 7), the effect became marginal when compared with adequate dosages of pharmacotherapy for OCD (g = 0.32: 95% CI -0.00 to 0.64, k = 6).A minority of studies (k = 8) were deemed to be at low risk of bias. Moreover, three quarters of studies (k = 28) demonstrated suspected researcher allegiance and these studies reported a large ES (g = 0.95: 95% CI 0.69 to 1.2), while those without suspected researcher allegiance (k = 8) indicated that CBT with ERP was not efficacious (g = 0.02: 95% CI -0.29 to 0.33). CONCLUSIONS A large effect size was found for CBT with ERP in reducing the symptoms of OCD, but depends upon the choice of comparator control. This meta-analysis also highlights concerns about the methodological rigor and reporting of published studies of CBT with ERP in OCD. In particular, efficacy was strongly linked to researcher allegiance and this requires further future investigation.
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Affiliation(s)
- Jemma E Reid
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK.
| | - Keith R Laws
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | | | - Matteo Vismara
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Benedetta Grancini
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Davis Mpavaenda
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Naomi A Fineberg
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
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Fineberg N, Van Ameringen M, Drummond L, Hollander E, Stein D, Geller D, Walitza S, Pallanti S, Pellegrini L, Zohar J, Rodriguez C, Menchon J, Morgado P, Mpavaenda D, Fontenelle L, Feusner J, Grassi G, Lochner C, Veltman D, Sireau N, Carmi L, Adam D, Nicolini H, Dell'Osso B. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr Psychiatry 2020; 100:152174. [PMID: 32388123 PMCID: PMC7152877 DOI: 10.1016/j.comppsych.2020.152174] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- N.A. Fineberg
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK,University of Cambridge School of Clinical Medicine, Cambridge, UK,Corresponding author at: University of Hertfordshire, Hatfield, UK.
| | - M. Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - L. Drummond
- SW London and St George's NHS Trust and St George's, University of London, UK
| | - E. Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - D.J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - D. Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - S. Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - S. Pallanti
- Istituto di Neuroscienze, University of Florence, Italy,Albert Einstein College of Medicine, New York, USA
| | - L. Pellegrini
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK,Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - J. Zohar
- The Post Trauma Center, Chaim Sheba Medical Center, Israel,Tel Aviv University, Israel
| | - C.I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - J.M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - P. Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS-3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal,Clinical Academic Center – Braga, Hospital de Braga, Braga, Portugal
| | - D. Mpavaenda
- University of Hertfordshire, Hatfield, UK,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, UK
| | - L.F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia,D'Or Institute for Research and Education and Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J.D. Feusner
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - G. Grassi
- Brain Center Firenze, Florence, Italy
| | - C. Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
| | - D.J. Veltman
- Department of Psychiatry, Amsterdam UMC location VUMC, Amsterdam, the Netherlands
| | - N. Sireau
- Orchard, 66 Devonshire Road, Cambridge CB1 2BL, UK
| | - L. Carmi
- The Post Trauma Center, Chaim Sheba Medical Center, Israel
| | | | - H. Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico,Clinical Research, Carracci Medical Group, Mexico City, Mexico
| | - B. Dell'Osso
- University of Milan, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy,“Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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Fineberg NA, Baldwin DS, Drummond LM, Wyatt S, Hanson J, Gopi S, Kaur S, Reid J, Marwah V, Sachdev RA, Pampaloni I, Shahper S, Varlakova Y, Mpavaenda D, Manson C, O’Leary C, Irvine K, Monji-Patel D, Shodunke A, Dyer T, Dymond A, Barton G, Wellsted D. Optimal treatment for obsessive compulsive disorder: a randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder. Int Clin Psychopharmacol 2018; 33:334-348. [PMID: 30113928 PMCID: PMC6166704 DOI: 10.1097/yic.0000000000000237] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/14/2018] [Indexed: 12/02/2022]
Abstract
Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50-200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were 'blinded' to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen's d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was -0.39 and versus sertraline was -0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447-0.3199) greater than for CBT and 0.1135 (95% confidence interval: -0.0290-0.2560), greater than for combined treatment. Combined treatment appeared the most clinically effective option, especially over CBT, but the advantages over SSRI monotherapy were not sustained beyond 16 weeks. SSRI monotherapy was the most cost-effective. A definitive study can and should be conducted.
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Affiliation(s)
- Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
- University of Hertfordshire, Hatfield
- University of Cambridge Clinical Medical School, Addenbrookes Hospital, Cambridge
| | - David S. Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
- Southern Health NHS Foundation Trust, College Keep, Southampton
| | - Lynne M. Drummond
- London and St George’s Mental Health NHS Trust
- St George’s Hospital, University of London, London
| | | | - Jasmine Hanson
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Srinivas Gopi
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Sukhwinder Kaur
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Jemma Reid
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
- University of Hertfordshire, Hatfield
| | - Virender Marwah
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Ricky A. Sachdev
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | | | - Sonia Shahper
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Yana Varlakova
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Davis Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Christopher Manson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
| | - Cliodhna O’Leary
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
| | - Karen Irvine
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
- University of Hertfordshire, Hatfield
| | - Deela Monji-Patel
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Ayotunde Shodunke
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City
| | - Tony Dyer
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Amy Dymond
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Menchón JM, van Ameringen M, Dell'Osso B, Denys D, Figee M, Grant JE, Hollander E, Marazziti D, Nicolini H, Pallanti S, Ruck C, Shavitt R, Stein DJ, Andersson E, Bipeta R, Cath DC, Drummond L, Feusner J, Geller DA, Hranov G, Lochner C, Matsunaga H, McCabe RE, Mpavaenda D, Nakamae T, O'Kearney R, Pasquini M, Pérez Rivera R, Poyurovsky M, Real E, do Rosário MC, Soreni N, Swinson RP, Vulink N, Zohar J, Fineberg N. Standards of care for obsessive-compulsive disorder centres. Int J Psychiatry Clin Pract 2016; 20:204-8. [PMID: 27359333 PMCID: PMC4950405 DOI: 10.1080/13651501.2016.1197275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.
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Affiliation(s)
- José M Menchón
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain ;,c Department of Clinical Sciences, School of Medicine , University of Barcelona , Barcelona , Spain
| | - Michael van Ameringen
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Bernardo Dell'Osso
- e Department of Psychiatry , University of Milan , Milan , Italy ;,f Fondazione IRCCS Ca' Granda Policlinico , Milan , Italy
| | - Damiaan Denys
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands ;,h Brain and Cognition , Amsterdam , The Netherlands ;,i Netherlands Institute for Neuroscience , Amsterdam , The Netherlands ;,j Royal Netherlands Academy of Arts and Sciences , Amsterdam , The Netherlands
| | - Martijn Figee
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Jon E Grant
- k Department of Psychiatry and Behavioral Neuroscience , University of Chicago , Chicago , IL , USA
| | - Eric Hollander
- l Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine , NY , USA ;,m Montefiore Medical Center , NY , USA
| | - Donatella Marazziti
- n Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria , University of Pisa , Pisa , Italy
| | - Humberto Nicolini
- o National Institute of Genomic Medicine , Mexico City , Mexico ;,p Carracci Medical Group , Mexico City , Mexico
| | - Stefano Pallanti
- q Psychiatry and Behavioral Sciences , UC Davis Health System , Sacramento , CA , USA ;,r Istituto di Neuroscienze , Florence , Italy
| | - Christian Ruck
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Roseli Shavitt
- t Department and Institute of Psychiatry , University of São Paulo School of Medicine , São Paulo , Brazil
| | - Dan J Stein
- u Psychiatry and Mental Health Department , University of Cape Town , Cape Town , South Africa ;,v Groote Schuur Hospital , Cape Town , South Africa ;,w MRC Unit on Anxiety and Stress Disorders , South Africa
| | - Erik Andersson
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | | | - Danielle C Cath
- y Department of Clinical Psychology , Utrecht University , Utrecht , The Netherlands
| | - Lynne Drummond
- z South West London and St George's Mental Health NHS Trust , London , United Kingdom ;,aa St George's, University of London , London , United Kingdom
| | - Jamie Feusner
- ab Semel Institute for Neuroscience and Human Behavior , Los Angeles , CA , USA ;,ac David Geffen School of Medicine at UCLA University of California , Los Angeles , CA , USA
| | - Daniel A Geller
- ad Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA ;,ae Harvard Medical School , Boston , MA , USA
| | | | - Christine Lochner
- w MRC Unit on Anxiety and Stress Disorders , South Africa ;,ag Department of Psychiatry , Stellenbosch University , South Africa
| | - Hisato Matsunaga
- ah Department of Neuropsychiatry , Hyogo College of Medicine , Nishinomiya , Hyogo , Japan
| | - Randy E McCabe
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,ai Anxiety Treatment and Research Center , St. Joseph's Healthcare Hamilton , Hamilton , Canada
| | - Davis Mpavaenda
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
| | - Takashi Nakamae
- ak Department of Psychiatry, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Richard O'Kearney
- al The Australian National University , Research School of Psychology , Canberra , Australia
| | - Massimo Pasquini
- am Department of Neurology and Psychiatry , Sapienza University of Rome , Rome , Italy
| | | | | | - Eva Real
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain
| | - Maria Conceição do Rosário
- ap Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Noam Soreni
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,aq Pediatric OCD Consultation Service, Anxiety Treatment and Research Center , St. Joseph's HealthCare , Hamilton , Ontario , Canada
| | - Richard P Swinson
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Nienke Vulink
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Joseph Zohar
- ar Tel Aviv University , Sackler School of Medicine , NY , USA
| | - Naomi Fineberg
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
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