scholarly journals A clinical significance analysis of manualised psychological interventions for obsessive-compulsive disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S285-S285
Author(s):  
Jake Rigby ◽  
Peter Fisher ◽  
Gemma Cherry ◽  
Taylor Stuart ◽  
James Temple
Keyword(s):  
Clinical Significance ◽  
Effect Size ◽  
Post Treatment ◽  
Effect Sizes ◽  
Group Effect ◽  
Obsessive Compulsive ◽  
Psychological Treatments ◽  
Compulsive Disorder ◽  
Treatment Type

AimsTo conduct an individual patient data meta-analysis of randomised controlled trials (RCTs) of manualised psychological treatments for obsessive-compulsive disorder (OCD), and examine the differential efficacy of psychological treatments by treatment type and format.BackgroundPrevious meta-analyses conclude that efficacious psychological treatments for OCD exist. However, determining the efficacy of psychological treatments requires multiple forms of assessment across a range of indexes, yet most previous meta-analyses in OCD are based solely on effect sizes.MethodWe evaluated treatment efficacy across 24 RCTs (n = 1,667) by conducting clinical significance analyses (using standardised Jacobson methodology) and standardised mean difference within-group effect-size analyses. Outcomes were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores, evaluated at post-treatment and follow-up (3-6 months post-treatment).ResultPost-treatment, there was a large significant within-group effect size for treated patients (g = 1.28) and a small significant effect size for controls (g = 0.30). At follow-up, large within-group effect sizes were found for both treated patients (g = 1.45) and controls (g = 0.90). Clinical significance analyses indicated that treated patients were significantly more likely than controls to recover following an intervention, but recovery rates were low; post-intervention, only 32% of treated patients and 3% of controls recovered; rising to 38% and 21% respectively at follow-up. Regardless of allocation, only approximately 20% of patients were asymptomatic at follow-up. Across the different analysis methods, individual cognitive therapy (CT) was the most effective intervention, followed by group CT plus exposure and response prevention. Self-help interventions were generally less effective.ConclusionReliance on aggregated within-group effect sizes may lead to overestimation of the efficacy of psychological treatments for OCD. More research is needed to determine the most effective treatment type and format for patients with OCD.

scholarly journals Obsessive-compulsive disorder: does CBT with exposure and response (ERP) prevention work?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S284-S285
Author(s):  
Jemma Reid ◽  
Naomi A Fineberg ◽  
Lynne Drummond ◽  
Keith Laws ◽  
Matteo Vismara ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Effect Size ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Obsessive Compulsive ◽  
Related Factors ◽  
Psychological Treatments ◽  
Compulsive Disorder ◽  
Control Intervention ◽  
Randomised Controlled

AimsSince the 1970s treatment for obsessive Compulsive Disorder (OCD) has consisted of the the application of drugs acting on the serotonin system of the brain or psychological treatments using graded exposure. Although there is a large number of studies on psychological treatments, they often are underpowered. Other major methodological issues include ignoring the effects of medication during the trial, using a variety of techniques and using waiting list data as controls.We decided to systematically review and perform a meta-analysis on randomised controlled trials (RCTs) of CBT with ERP (abbreviated to ERP)1.MethodThe study was preregistered in PROSPERO (CRD42019122311). RCTs incorporating ERP were examined. The primary outcome was the end-of-trial symptoms scores for OCD. In addition, factors which may have influenced the outcome including patient-related factors, type of control intervention, researcher allegiance and other potential forms of bias were examined. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were also examined.ResultOverall, 36 studies were included in the analyses, involving 537 children/adolescents and 1483 adults (total 2020 subjects). A total of 1005 received ERP and the remainder a variety of control treatments. Initial results showed that ERP had a large effect size compared with placebo treatments. This was more marked in younger than older persons. However, whereas ERP was markedly more effective than waiting list or psychological control, this positive effect size disappeared when it was compared with other psychological treatments.When ERP was compared against psychopharmacological treatment it initially appeared significantly superior but this reduced to marginal benefit when compared with adequate doses of appropriate medication.The majority of studies were performed where there may be expected to be researcher allegiance to ERP and in these studies the effect size was large. In contrast, in the 8 studies considered to have low risk of researcher bias, ERP was found to be ineffective.ConclusionAlthough on initial sight CBT incorporating ERP seems to be highly efficacious in the treatment of OCD, further analysis revealed that this varied depending on the choice of comparator control. In addition there are considerable concerns about methodological rigour and reporting of studies using CBT with ERP. Further studies examining the role of researcher bias and allegiance are needed.Ref : 1 Jemma E Reid, Keith R Laws, Lynne Drummond, Matteo Vismara, Benedetta Grancini , Davis Mpavaenda, Naomi A Fineberg (2021) 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. Comprehensive Psychiatry , in press.

Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up

2009 ◽  
Vol 38 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Elena Cabedo ◽  
Amparo Belloch ◽  
Carmen Carrió ◽  
Christina Larsson ◽  
Héctor Fernández-Alvarez ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Post Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
One Year ◽  
The One ◽  
The Individual ◽  
Group Cbt

Background: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. Aims: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. Method: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. Results: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. Conclusions: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: Changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up

2011 ◽  
Vol 187 (1-2) ◽  
pp. 174-179 ◽  
Author(s):  
Amparo Belloch ◽  
Elena Cabedo ◽  
Carmen Carrió ◽  
Héctor Fernández-Alvarez ◽  
Fernando García ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Group Versus ◽  
Post Treatment ◽  
Obsessive Compulsive ◽  
Cognitive Treatment ◽  
Compulsive Disorder ◽  
One Year

Efficacy of CBT Plus Acceptance & Commitment Therapy Versus CBT Alone for Obsessive-compulsive Disorder. Protocol for a Randomised Single-blinded Superiority Trial

2017 ◽  
Vol 41 (S1) ◽  
pp. S643-S643
Author(s):  
A. Pozza ◽  
S. Domenichetti ◽  
N. Giaquinta ◽  
D. Davide
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Post Treatment ◽  
Medium Effect ◽  
Obsessive Compulsive ◽  
Random Factor ◽  
Compulsive Disorder ◽  
Commitment Therapy ◽  
Secondary Endpoints ◽  
Secondary Outcomes

IntroductionCognitive behavioural therapy (CBT) is the first-line psychological treatment for Obsessive-Compulsive Disorder (OCD). However, 30% of individuals have a null or partial response. Preliminary evidence suggested that Acceptance & Commitment Therapy (ACT) may be effective. No study investigated whether the association of CBT with ACT may improve outcomes of CBT alone.ObjectivesThis paper presents the protocol of a trial where individuals with OCD will be randomly assigned to CBT alone or CBT plus ACT. Primary endpoints will be the number of individuals meeting OCD diagnostic criteria at post-treatment and follow-up. Secondary endpoints will be self-reported depression, anxiety, disgust and guilt, and obsessive beliefs. It is hypothesized that CBT plus ACT is associated to fewer individuals meeting OCD criteria and greater reductions in secondary endpoints.MethodsA single-blinded superiority randomised design will be used. Primary/secondary outcomes will be administered at baseline, post-treatment and 6-month follow-up. Treatment duration will be 25 weekly sessions in both conditions. Individuals (age ≥ 18 years) with OCD diagnosis will be recruited at mental health services in a 60.000 inhabitants area in Italy. Chi squared will be computed to test group differences on OCD diagnosis. ANCOVAs will be calculated entering baseline scores as covariates, group allocation as random factor and primary/secondary outcomes as dependent variables.ResultsTo obtain a medium effect size, 80% power and 0.05 significance, a priori power analysis suggests inclusion for at least 34 individuals as total sample.ConclusionsA description of the protocol will be provided. Strengths and potential limitations will be addressed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Long-term stability of benefits of cognitive behavioral therapy for obsessive compulsive disorder depends on symptom remission during treatment

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Björn Elsner ◽  
Frieder Wolfsberger ◽  
Jessica Srp ◽  
Antonia Windsheimer ◽  
Laura Becker ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Roc Curves ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Background Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and may afford stable long-term improvements. It is not clear, however, how stability or symptom recurrence can be predicted at the time of termination of CBT. Method In a 1-year follow-up intention-to-treat study with 120 OCD patients receiving individual CBT at a university outpatient unit, we investigated the predictive value of international consensus criteria for response only (Y-BOCS score reduction by at least 35%) and remission status (Y-BOCS score ≤ 12). Secondly, we applied receiver-operating characteristic (ROC) curves in order to find an optimal cut-off score to classify for deterioration and for sustained gains. Results Response only at post-treatment increased the likelihood of deterioration at follow-up compared to remission at an odds ratio of 8.8. Moreover, ROC curves indicated that a post-treatment score of ≥ 13 differentiated optimally between patients with and without symptom deterioration at follow-up assessment. The optimal cut-off score to classify for any sustained gains (response, remission, or both) at follow-up relative to baseline was 12. Importantly, previous findings of generally high long-term symptom stability after treatment in OCD could be replicated. Conclusion The findings highlight the clinical importance of reaching remission during CBT, and suggest that a recently published expert consensus for defining remission has high utility.

scholarly journals Metacognitive Change During Exposure and Metacognitive Therapy in Obsessive-Compulsive Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Jana Hansmeier ◽  
Anke Haberkamp ◽  
Julia A. Glombiewski ◽  
Cornelia Exner
Keyword(s):  
Treatment Outcome ◽  
Obsessive Compulsive Disorder ◽  
Pilot Trial ◽  
Post Treatment ◽  
Metacognitive Therapy ◽  
Obsessive Compulsive ◽  
Significant Interaction Effect ◽  
Compulsive Disorder ◽  
Patient Rating

Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption that metacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.

scholarly journals A Naturalistic Study of the Maintenance of Gains Made With Treatment of Patients With Profound Treatment-Refractory Obsessive-Compulsive Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Nighat Jahan Nadeem ◽  
Emily Chan ◽  
Lynne Drummond
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Post Treatment ◽  
Inpatient Service ◽  
Obsessive Compulsive ◽  
Similar Reduction ◽  
Compulsive Disorder ◽  
The United Kingdom ◽  
Paired Student ◽  
Treatment Refractory

Obsessive-compulsive disorder (OCD) generally responds to first-line treatment but patients often relapse. The United Kingdom National OCD Inpatient Service treats patients who have failed to respond to at least two trials of SRI, augmented with a dopamine blocker and two trials of ERP. Despite this, they have profound treatment-refractory OCD and require 24-h nursing care due to severe OCD. We examined patients' Y-BOCS score on admission, discharge and at each follow-up from all patients discharged over 5 years (02/01/2014-31/12/18). Data were analysed using SPSS. Paired student t-tests were used to assess improvement from admission to discharge and each follow-up. Over 5 years, 130 adult patients were treated: 79 male and 51 female with an average age of 42.3 years (20-82; sd14.4). Their ethnic backgrounds were; 115 Caucasian, 11 South Asian, 1 Chinese, and 3 Unspecified. On admission, the average Y-BOCS total score was 36.9 (30-40; sd2.6). At discharge, patients had improved on average by 36% (Y-BOCS reduction to 23.4 = moderate OCD). Similar reduction in Y-BOCS continued throughout the year with an average Y-BOCS of 22.9 at 1 month (n = 69); 23 at 3 months (n = 70); 21.3 at 6 months (n = 78) and 21.9 at 1 year (n = 77). Twenty-seven patients did not attend any follow-up appointment whilst others attended at least one appointment with the majority attending more than 3. Using student t-test, improvements at discharge, 1, 3, 6, and 12 months post-treatment showed a highly significant improvement (p < 0.001). Gains made following inpatient treatment for treatment-refractory OCD were generally maintained until 1 year post-treatment.

scholarly journals Post-treatment predictors of follow-up status for obsessive-compulsive disorder treated with concentrated exposure therapy

2018 ◽  
Vol 5 (1) ◽  
pp. 1461542
Author(s):  
Silje Elisabeth Hasmo Holm ◽  
Bjarne Hansen ◽  
Gerd Kvale ◽  
Thomas Eilertsen ◽  
Torun Grøtte ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment Predictors

Adapted cognitive behavior therapy for obsessive compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study

2018 ◽  
Author(s):  
Oskar Flygare ◽  
Erik Andersson ◽  
Helene Ringberg ◽  
Anna-Clara Hellstadius ◽  
Johan Edbacken ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Depressive Symptoms ◽  
Obsessive Compulsive Disorder ◽  
Clinical Effectiveness ◽  
Autism Spectrum ◽  
Post Treatment ◽  
Spectrum Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) commonly co-occur. Adapted CBT for OCD in adults with ASD has not previously been evaluated outside the United Kingdom. In this study, 19 adults with OCD and ASD were treated using an adapted CBT protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale (YBOCS). Participants were assessed up to 3 months after treatment. There were significant reductions on the YBOCS at post-treatment (d=1.5), and improvements were sustained at follow-up (d=1.2). Self-rated OCD symptoms and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from OCD. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted CBT for OCD in adults with co-occurring ASD is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.

scholarly journals Concentrated ERP Delivered in a Group Setting: A Replication Study

2017 ◽  
Vol 45 (5) ◽  
pp. 530-536 ◽  
Author(s):  
Audun Havnen ◽  
Bjarne Hansen ◽  
Lars-Göran Öst ◽  
Gerd Kvale
Keyword(s):  
Group Treatment ◽  
Treatment Satisfaction ◽  
Original Study ◽  
Post Treatment ◽  
Secondary Outcome ◽  
Effectiveness Study ◽  
Group Setting ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Background: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. Aims: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Method: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. Results: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. Conclusions: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.

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