|
1
|
Storch EA, Cheng JS, Higham M, Muñoz JS, Cruz VZ, Berrones D, Obando DP, Anderberg JL, Frederick RM, Tapia-Cuevas V, Muñoz MC, Villar CU, Moya PR, Ochoa-Panaifo ME, Mallen MCM, Wiese AD, Pinciotti CM, Sagarnaga MN, McGuire JF, Onyeka OC, Moyano MB, Goodman WK, Crowley JJ. Psychometric properties of the Spanish Yale-Brown Obsessive-Compulsive Scale - Second Edition. Psychiatry Res 2025; 348:116456. [PMID: 40188616 DOI: 10.1016/j.psychres.2025.116456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 03/13/2025] [Accepted: 03/21/2025] [Indexed: 04/08/2025]
Abstract
The Yale-Brown Obsessive-Compulsive Scale, Second Edition (Y-BOCS-II) is an evidence-based clinician-rated measure for assessing the presence and severity of obsessive-compulsive symptoms. The Spanish version of the Y-BOCS-II has not yet been validated. The present study examines the psychometric properties of the Spanish Y-BOCS-II (Spanish-Y-BOCS-II) in adults with obsessive-compulsive disorder (OCD) who are of Hispanic/Latino ancestry. The Spanish-Y-BOCS-II was administered to 1805 adults with OCD. Participants also completed a battery of measures assessing OCD, depression, and anxiety symptoms. The internal consistency for the Symptom Checklist (Kuder-Richardson-20=0.92), Obsession Severity (α=0.87), Compulsion Severity (α=0.86), and Total Severity (α=0.92) were high. The inter-rater reliability for the Severity Scale (intraclass correlations=0.98) was excellent. Confirmatory factor analyses showed a marginally acceptable fit with the Obsessions and Compulsions two-factor model; subsequent exploratory factor analysis revealed a one-factor solution consistent with a Total score including all items. Satisfactory construct validity was observed, supported by the strong correlations with other measures of obsessive-compulsive symptom severity and moderate correlations with measures of depression and anxiety symptoms. Overall, the Spanish-Y-BOCS-II demonstrates acceptable reliability and validity properties.
Collapse
Affiliation(s)
- Eric A Storch
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States.
| | - Jessica Sc Cheng
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Miranda Higham
- Department of Education, University of Florida, Gainesville, Florida, United States
| | - Josselyn S Muñoz
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Vanessa Zavala Cruz
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Dayan Berrones
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Diana P Obando
- Facultad de Psicología y Ciencias del Comportamiento, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - Jacey L Anderberg
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States; Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States
| | - Renee M Frederick
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States; Department of Psychology, University of Houston, Houston, Texas, United States
| | | | - Macarena Churruca Muñoz
- Centro Interdisciplinario de Neurociencia de Valparaíso, Valparaíso, Chile; Centro de Estudios Traslacionales en Estres y Salud Mental C-ESTRES, Valparaíso, Chile
| | | | - Pablo R Moya
- Centro Interdisciplinario de Neurociencia de Valparaíso, Valparaíso, Chile; Centro de Estudios Traslacionales en Estres y Salud Mental C-ESTRES, Valparaíso, Chile; Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | | | | | - Andrew D Wiese
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Caitlin M Pinciotti
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - Melisa N Sagarnaga
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina; Peer Support Argentina, Buenos Aires, Argentina
| | - Joseph F McGuire
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ogechi C Onyeka
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - María B Moyano
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Argentina; Departamento de Investigación, Asociación de Psiquiatras de Argentina (APSA), Buenos Aires, Argentina
| | - Wayne K Goodman
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
| | - James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| |
Collapse
|
|
2
|
Hall CE, Greenberg N. A service evaluation of PTSD Resolution therapy for military veterans. Occup Med (Lond) 2025:kqaf012. [PMID: 40163656 DOI: 10.1093/occmed/kqaf012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) Resolution is a UK-based charity that provides treatment for military veterans, reservists and their families. However, there is little contemporary evaluation of their clinical outcomes to inform commissioners or potential service users. AIMS To establish whether treatment by PTSD Resolution therapists resulted in positive outcomes at the end of therapy and follow-up; to establish risk and resilience factors associated with positive treatment outcomes; and to the extent possible, compare PTSD Resolution with National Health Service (NHS)-Improving Access to Psychological Therapies (IAPT) services. METHODS A sample of 211 closed cases from the service provider between April 2022 and May 2023 were utilized. Clients provided demographic data and completed a series of mental health screening tools. Follow-up data were also collected where possible. Paired t-tests, univariable binary logistic regressions and chi-squared tests were used in the analysis. RESULTS Around 6% of clients attended only one session, with 82% having a planned ending. This service evaluation suggests that veterans who enter therapy with PTSD Resolution appear to experience similar rates of recovery to IAPT users. Analysis of follow-up data revealed that clients scores slightly increased following the completion of therapy but remained below caseness thresholds and significantly lower than entry-level scores. CONCLUSIONS These data suggest that veterans who choose to engage with PTSD Resolution for their mental health difficulties should expect to experience a similar benefit to that they would have experienced if they had sought outpatient care from the NHS.
Collapse
Affiliation(s)
- C E Hall
- Department of Psychological Medicine, King's College London, London SE5 9RJ, UK
| | - N Greenberg
- Department of Psychological Medicine, King's College London, London SE5 9RJ, UK
| |
Collapse
|
|
3
|
Trent ES, Zhou RJ, Mammo L, Goodman WK, Storch EA. High intensity approaches to exposure and response prevention for obsessive-compulsive disorder. Behav Brain Res 2025; 481:115427. [PMID: 39798884 DOI: 10.1016/j.bbr.2025.115427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/24/2024] [Accepted: 12/12/2024] [Indexed: 01/15/2025]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with multidetermined etiological and maintaining mechanisms. Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP), is the first line behavioral intervention to treat OCD. ERP directly targets threat learning that characterizes OCD through processes of habituation (fear extinction) and inhibitory learning, in addition to eliciting neuronal changes implicated in OCD. Although ERP has a strong evidence base, not all OCD patients respond fully to standard, weekly or twice-weekly outpatient ERP. High intensity ERP-treatment delivered through more and/or longer sessions in a condensed manner-is a potential alternative approach that has also demonstrated efficacy for adults and youth with OCD. The goal of this review article is to describe the nature, rationale, and evidence for high intensity ERP for OCD treatment. We describe the foundations of ERP for OCD, various formats of intensive ERP, clinical research on the efficacy of this approach including neuronal changes, and potential pharmacological and neurosurgical augmentation strategies. We conclude with limitations of the current literature on intensive approaches and recommendations for future directions. While additional research is needed, high intensity ERP may be a promising approach for patients who have not responded to standard ERP or for patients requiring rapid symptom improvement.
Collapse
Affiliation(s)
- Erika S Trent
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States.
| | - Robert J Zhou
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Liya Mammo
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Wayne K Goodman
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| | - Eric A Storch
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, United States
| |
Collapse
|
|
4
|
Ishikawa R. Cognitive Behavioural Therapy for Obsessive-Compulsive Disorder Related to the Fear of Internet Use: A Case Study. Cureus 2024; 16:e70584. [PMID: 39483930 PMCID: PMC11525089 DOI: 10.7759/cureus.70584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 11/03/2024] Open
Abstract
Obsessive-compulsive disorder's (OCD's) symptomatology appears to evolve with modern developments, with recent reports highlighting the influence of modern technologies (e.g., the Internet); for instance, some OCD cases are characterised by an excessive fear of Internet use. Meanwhile, cognitive behavioural therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional thoughts, behaviours, and emotions, and has proven effective for various psychological issues, including OCD; however, research on OCD related to the fear of Internet use and its treatment remains limited. The present study presents a case of a patient who had been suffering from severe OCD for approximately one year, exhibiting a fear of using the Internet due to intrusive urges to send offensive messages (e.g., death threats) when near computers. This fear led to avoidance of Internet use and compulsive checking to ensure that Internet-connected devices were turned off. The treatment involved a combination of CBT and medication (fluvoxamine). The case formulation focused on identifying thought-action-fusion-misinterpretations that exacerbate and maintain OCD (maladaptive appraisals about an increase in the probability of an unpleasant event by merely thinking about it); it also addressed cognitive and behavioural factors, including safety behaviours such as reassurance-seeking and thought suppression. To address and alter maladaptive interpretations and behaviours, CBT was implemented using various techniques, including behavioural experiments, which included the 'on duty versus off duty' tactic to relieve the patient from the responsibility of controlling aggressive thoughts, refraining from covering his computer or smartphone, intentionally looking at them frequently, and browsing various Internet forums and review sites. Through these experiments, the patient realised that his negative predictions were unfounded and that avoiding Internet use was unnecessary. The patient's self-reported OCD symptoms, measured using the Japanese versions of the Yale-Brown Obsessive-Compulsive Scale and the Obsessive-Compulsive Inventory, decreased over the course of 10 sessions. This case study demonstrates that empirically supported CBT can effectively treat OCD related to aggressive obsessions and the fear of Internet use. Its limitations included that the patient was receiving both fluvoxamine and CBT (thus making it difficult to attribute the improvement solely to CBT) and that this study focused on a single patient setting (thereby making it difficult to generalize its findings).
Collapse
|
|
5
|
Pittenger C. The Pharmacological Treatment of Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:107-119. [PMID: 36740347 DOI: 10.1016/j.psc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Pharmacological treatment is a mainstay of the care of individuals with obsessive-compulsive disorder. Robust evidence supports the use of the selective serotonin reuptake inhibitors and the older tricyclic drug clomipramine. Other antidepressants are less effective (or have been insufficiently studied). When first-line treatment with these agents, and with appropriate psychotherapy, is ineffective, several augmentation strategies are available, though their evidentiary support is weaker. A substantial minority of patients have persistent symptoms despite optimal evidence-based treatment. Further work and more treatment options are needed.
Collapse
Affiliation(s)
- Christopher Pittenger
- Departments of Psychiatry, Psychology, and Child Study Center, and Center for Brain and Mind Health, Yale University.
| |
Collapse
|
|
6
|
Song Y, Li D, Zhang S, Jin Z, Zhen Y, Su Y, Zhang M, Lu L, Xue X, Luo J, Liang M, Li X. The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis. Psychiatry Res 2022; 317:114861. [PMID: 36179591 DOI: 10.1016/j.psychres.2022.114861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 01/04/2023]
Abstract
This meta-analysis mainly examined the effect size of exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) when compared with different control conditions, and the difference in the efficacy of different variants of ERP in the treatment of OCD. Thirty studies were included, involving 39 randomized controlled trials with 1793 participants, from 30 studies up to January 18, 2022. Hedge's g was calculated using random-effects models. The results showed that ERP had a definite effect on OCD (g = 0.37), and its effect was significant when the control condition was placebo (g = 0.97) or drug (g = 0.59). However, ERP did not show statistical differences with other therapies in improving OCD (g = -0.07). In addition, we found that both therapist and self-controlled exposure (at the same time as the therapist controls, self-control is exercised after the therapy session) and total response prevention can better improve OCD symptoms. In addition, compared with the control group, ERP reduced depression (g = 0.15) and anxiety symptoms (g = 0.23) in patients with OCD. Meta-regression results showed that the longer the length of sessions, the better the treatment effect (t = 2.41, p = 0.022).
Collapse
Affiliation(s)
- Yuqi Song
- Centre for Translational Medicine, Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China; Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei Anhui 230032, China
| | - Dongxu Li
- Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei Anhui 230032, China
| | - Shuyu Zhang
- School of Psychology, the Australian First University, Australia
| | - Zirong Jin
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Zhen
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Yiyang Su
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Muzi Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Liuyang Lu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Xiangrui Xue
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Jingyi Luo
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Meng Liang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoming Li
- Centre for Translational Medicine, Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
|
7
|
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: 5] [Impact Index Per Article: 1.7] [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.
Collapse
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
| |
Collapse
|
|
8
|
Naß J, Abdelfatah S, Efferth T. The triterpenoid ursolic acid ameliorates stress in Caenorhabditis elegans by affecting the depression-associated genes skn-1 and prdx2. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 88:153598. [PMID: 34111615 DOI: 10.1016/j.phymed.2021.153598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Depression is one of the leading causes of death worldwide. Lower antioxidant concentrations and increased oxidative stress levels contribute to the development of depression. Effective and tolerable medications are urgently needed. Nrf2 and PRDX2 are promising targets in the treatment of oxidative stress and, therefore, promising for the development of novel antidepressants. Ursolic acid (UA), a natural triterpenoid found in various plants is known to exert neuroprotective and antioxidant effects. Skn-1 (which corresponds to human Nrf2) and prdx2 deficient mutants of the nematode Caenorhabditis elegans are suitable models to study the effect of UA on these targets. Additionally, stress assays are used to mimic stress or depressed state. METHODS We examined the antioxidant activity of UA in Caenorhabditis elegans wildtype and skn-1- and prdx2-deficient strains by H2DCF-DA and juglone assays as well as osmotic and heat stress assays. Additionally, we analyzed the binding of UA to human PRDX2 and Skn-1 proteins by molecular docking and microscale thermophoresis. RESULTS UA exerted strong antioxidant activities. Additionally, induction of stress resistance towards osmotic and heat stress was observed. qRT-PCR revealed that UA upregulated the gene expression of skn-1 and prdx2. Molecular docking studies supported these findings. CONCLUSION Our findings implicate that the strong antioxidant activity of UA may exert anti-depressive effects by its interaction with the Skn-1 transcription factor, which is part of a detoxification network, and the antioxidant PRDX2 protein, which protects the organism from the detrimental effects of radical oxygen species.
Collapse
Affiliation(s)
- Janine Naß
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Sara Abdelfatah
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany.
| |
Collapse
|
|
9
|
Levy HC, O'Bryan EM, Tolin DF. A meta-analysis of relapse rates in cognitive-behavioral therapy for anxiety disorders. J Anxiety Disord 2021; 81:102407. [PMID: 33915506 DOI: 10.1016/j.janxdis.2021.102407] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Cognitive-behavioral therapy (CBT) is a first-line treatment for anxiety and related disorders, with large pre- to post-treatment effect sizes. Rates of relapse, or the likelihood that a state of remission will be maintained once treatment is withdrawn, have been relatively neglected in CBT outcome studies. The present meta-analysis aimed to determine the overall rate of relapse in CBT for anxiety and related disorders. A secondary aim was to assess whether demographic, clinical, and methodological factors were associated with rates of relapse in CBT. Articles were identified from prior CBT meta-analyses and review papers and from literature searches using the PsycINFO and Medline electronic databases, with 17 full-length articles retained for meta-analysis (total N = 337 patients). Results showed an overall relapse rate of 14 %, which did not significantly differ between diagnoses. The way in which relapse was defined was significantly associated with relapse rates; when relapse was defined as meeting diagnostic criteria, estimates were lower than when alternative definitions were used. The findings indicate that relapse following symptom remission occurs in a minority of patients, suggesting that future treatment development and refinement efforts should focus on improving relapse prevention skills and interventions to minimize risk of relapse.
Collapse
Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA.
| | - Emily M O'Bryan
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT, 06106, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| |
Collapse
|
|
10
|
Petrocchi N, Cosentino T, Pellegrini V, Femia G, D'Innocenzo A, Mancini F. Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design. Front Psychol 2021; 11:594277. [PMID: 33510677 PMCID: PMC7835278 DOI: 10.3389/fpsyg.2020.594277] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.
Collapse
Affiliation(s)
- Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, Rome, Italy.,Compassionate Mind Italia, Rome, Italy
| | | | - Valerio Pellegrini
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Antonella D'Innocenzo
- Compassionate Mind Italia, Rome, Italy.,Scuola di Psicoterapia Cognitiva S.r.l., Rome, Italy
| | - Francesco Mancini
- Scuola di Psicoterapia Cognitiva S.r.l., Rome, Italy.,Department of Psychological Sciences, Guglielmo Marconi University, Rome, Italy
| |
Collapse
|
|
11
|
Innovations in the Delivery of Exposure and Response Prevention for Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:301-329. [PMID: 33590457 DOI: 10.1007/7854_2020_202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obsessive-Compulsive Disorder is an important cause of global health-related disability. In the last several decades, exposure and response prevention (EX/RP) has emerged as one of the most evidence-based treatments for adult and pediatric OCD. Recommended as a first-line treatment in practice guidelines for OCD, EX/RP, when expertly delivered, can be superior to serotonin reuptake inhibitor (SRI) medications alone and superior to adding antipsychotic medication to augment SRI treatment response. Despite a robust evidence base, EX/RP is not widely available. Moreover, although effective, only about half of patients who receive a standard course of EX/RP will achieve remission.This chapter will review innovations in delivering EX/RP, focusing on technology-based methods designed to increase access to EX/RP and translational neuroscience approaches to personalizing and optimizing EX/RP. Technology-based innovations to deliver EX/RP include video conferencing, internet-based treatment, and smartphone apps. Of these, internet-based, clinician-supported treatment has the most evidence base to date. Relevant to all technology-based innovations are the need for advances in the ethical, regulatory and financial aspects of understanding how access to EX/RP may be delivered to individuals of diverse socioeconomic backgrounds in accordance with professional standards and regulations and covered by healthcare.Advances in our understanding of the neural processes underlying learning and memory have led to new ways to combine EX/RP with medications, behavioral interventions, or neuromodulatory methods, with the goal of enhancing the functioning of brain circuits that subserve fear processing and cognitive control. Among the pharmacological approaches to enhancing EX/RP outcome, both ketamine and cannabinoids show promise in small open trials but are in need of further study. Studies to train cognitive control are at an early stage of development yet provide preliminary evidence that training neural processes may be a new path to personalize treatment. How best to combine EX/RP with different types of neuromodulation is being actively studied.Together these innovations in the delivery of EX/RP for OCD hold great promise for improving outcomes of care for individuals with OCD by increasing the availability and the individual treatment effects of this already effective treatment.
Collapse
|
|
12
|
Mehta K, Mehta S, Chalana H, Singh H, Thaman RG. Effectiveness of Rajyoga meditation as an adjunct to first-line treatment in patients with obsessive compulsive disorder. Indian J Psychiatry 2020; 62:684-689. [PMID: 33896974 PMCID: PMC8052887 DOI: 10.4103/psychiatry.indianjpsychiatry_401_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/05/2019] [Accepted: 09/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Yoga is a set of mental, physical, and spiritual practices with its origin in ancient India. The renewed interest in Yoga has led to the exploration of its benefits in a variety of psychiatric disorders such as schizophrenia, depression, and anxiety disorders. There is a dearth of literature on the effect of yoga in obsessive compulsive disorder (OCD) in the Indian context. AIM The present study was conducted to find out the efficacy of Rajyoga meditation (RM) as an adjunct to the first-line treatment in the treatment of OCD. MATERIALS AND METHODS Patients with OCD (diagnosed according to Diagnostic and Statistical Manual of Mental Disorders fifth edition) were divided into two groups - (i) The meditation group (MG), which included 28 patients and (ii) The nonmeditative group (NMG), which included 22 patients. MG practiced RM protocol for 3 months duration in addition to the pharmacological treatment. The NMG continued on pharmacological management as usual. The symptomatology was assessed at baseline and 3 months using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS At 3 months, both groups demonstrated improvement in symptoms. The improvement in MG was statistically significant with a change of 9.0 ± 3.16 in Y-BOCS and a 49.76 ± 9.52% reduction in symptoms. Improvement scores of NMG were also statistically significant with a change of 3.13 ± 2.59 in Y-BOCS and 18.09 ± 14.69% reduction in symptoms. MG showed significantly more improvement in Y-BOCS scores (49.76 ± 9.52) as compared to NMG (18.09 ± 14.69) using the student's paired t-test (P < 0.001). CONCLUSION The present study suggests that the RM is an effective adjunctive therapy to reduce obsessions and compulsions in patients with OCD.
Collapse
Affiliation(s)
- Kiran Mehta
- Department of Physiology, SGRD Institute of Medical Sciences and Research, Amritsar, India
| | - Shivangi Mehta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Harsh Chalana
- Department of Psychiatry, SGRD Institute of Medical Sciences and Research, Amritsar, India
| | - Harjot Singh
- Department of Psychiatry, SGRD Institute of Medical Sciences and Research, Amritsar, India
| | - Richa Ghay Thaman
- Department of Physiology, SGRD Institute of Medical Sciences and Research, Amritsar, India
| |
Collapse
|
|
13
|
Cyr M, Pagliaccio D, Yanes-Lukin P, Fontaine M, Rynn MA, Marsh R. Altered network connectivity predicts response to cognitive-behavioral therapy in pediatric obsessive-compulsive disorder. Neuropsychopharmacology 2020; 45:1232-1240. [PMID: 31952071 PMCID: PMC7235012 DOI: 10.1038/s41386-020-0613-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/21/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) is commonly associated with alterations in cortico-striato-thalamo-cortical brain networks. Yet, recent investigations of large-scale brain networks suggest that more diffuse alterations in brain connectivity may underlie its pathophysiology. Few studies have assessed functional connectivity within or between networks across the whole brain in pediatric OCD or how patterns of connectivity associate with treatment response. Resting-state functional magnetic resonance imaging scans were acquired from 25 unmedicated, treatment-naive children and adolescents with OCD (12.8 ± 2.9 years) and 23 matched healthy control (HC) participants (11.0 ± 3.3 years) before participants with OCD completed a course of cognitive-behavioral therapy (CBT). Participants were re-scanned after 12-16 weeks. Whole-brain connectomic analyses were conducted to assess baseline group differences and group-by-time interactions, corrected for multiple comparisons. Relationships between functional connectivity and OCD symptoms pre- and post-CBT were examined using longitudinal cross-lagged panel modeling. Reduced connectivity in OCD relative to HC participants was detected between default mode and task-positive network regions. Greater (less altered) connectivity between left angular gyrus and left frontal pole predicted better response to CBT in the OCD group. Altered connectivity between task-positive and task-negative networks in pediatric OCD may contribute to the impaired control over intrusive thoughts early in the illness. This is the first study to show that altered connectivity between large-scale network regions may predict response to CBT in pediatric OCD, highlighting the clinical relevance of these networks as potential circuit-based targets for the development of novel treatments.
Collapse
Affiliation(s)
- Marilyn Cyr
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA. .,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - David Pagliaccio
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Paula Yanes-Lukin
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Martine Fontaine
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Moira A. Rynn
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Rachel Marsh
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| |
Collapse
|
|
14
|
van Dis EAM, van Veen SC, Hagenaars MA, Batelaan NM, Bockting CLH, van den Heuvel RM, Cuijpers P, Engelhard IM. Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:265-273. [PMID: 31758858 PMCID: PMC6902232 DOI: 10.1001/jamapsychiatry.2019.3986] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited. OBJECTIVE This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy, or waiting list) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). DATA SOURCES English-language publications were identified from PubMed, PsycINFO, Embase, Cochrane, OpenGrey (1980 to January 2019), and recent reviews. The search strategy included a combination of terms associated with anxiety disorders (eg, panic or phobi*) and study design (eg, clinical trial or randomized controlled trial). STUDY SELECTION Randomized clinical trials on posttreatment and at least 1-month follow-up effects of cognitive behavioral therapy compared with control conditions among adults with generalized anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobia, PTSD, or OCD. DATA EXTRACTION AND SYNTHESIS Researchers independently screened records, extracted statistics, and assessed study quality. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Hedges g was calculated for anxiety symptoms immediately after treatment and at 1 to 6 months, 6 to 12 months, and 12 months or more after treatment completion. RESULTS Of 69 randomized clinical trials (4118 outpatients) that were mainly of low quality, cognitive behavioral therapy compared with control conditions was associated with improved outcomes after treatment completion and at 1 to 6 months and at 6 to 12 months of follow-up for a generalized anxiety disorder (Hedges g, 0.07-0.40), panic disorder with or without agoraphobia (Hedges g, 0.22-0.35), social anxiety disorder (Hedges g, 0.34-0.60), specific phobia (Hedges g, 0.49-0.72), PTSD (Hedges g, 0.59-0.72), and OCD (Hedges g, 0.70-0.85). At a follow-up of 12 months or more, these associations were still significant for generalized anxiety disorder (Hedges g, 0.22; number of studies [k] = 10), social anxiety disorder (Hedges g, 0.42; k = 3), and PTSD (Hedges g, 0.84; k = 5), but not for panic disorder with or without agoraphobia (k = 5) and could not be calculated for specific phobia (k = 1) and OCD (k = 0). Relapse rates after 3 to 12 months were 0% to 14% but were reported in only 6 randomized clinical trials (predominantly for panic disorder with or without agoraphobia). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis suggest that cognitive behavioral therapy for anxiety-related disorders is associated with improved outcomes compared with control conditions until 12 months after treatment completion. At a follow-up of 12 months or more, effects were small to medium for generalized anxiety disorder and social anxiety disorder, large for PTSD, and not significant or not available for other disorders. High-quality randomized clinical trials with 12 months or more of follow-up and reported relapse rates are needed.
Collapse
Affiliation(s)
- Eva A. M. van Dis
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Suzanne C. van Veen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Muriel A. Hagenaars
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Neeltje M. Batelaan
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, location Vrije Universiteit medisch centrum, Amsterdam, the Netherlands
| | - Claudi L. H. Bockting
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, location Academisch Medisch Centrum, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Iris M. Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
|
15
|
Cucchi A, Liuzza MT, Saleem ZA, Al Hemiary NJ. A Study on the Effectiveness of Cognitive Behavioural Therapy for Obsessive Compulsive Behaviour in Iraq: Lessons for Cross-cultural Practice. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-019-00065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
16
|
Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol 2020; 17:710-736. [PMID: 30101713 PMCID: PMC7059159 DOI: 10.2174/1570159x16666180813155017] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Objective: Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. Methods: We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Results: Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance. Conclusions: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
Collapse
Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Alessio Padovano
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| |
Collapse
|
|
17
|
Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag 2019; 12:1167-1174. [PMID: 31920413 PMCID: PMC6935308 DOI: 10.2147/prbm.s211117] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022] Open
Abstract
Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological perspective and summarizes the evidence supporting the efficacy of ERP across child and adult populations. Next, we discuss predictors of ERP treatment outcome and discuss implementation strategies designed to improve feasibility and adoption. Finally, strategies to improve treatment dissemination are discussed.
Collapse
Affiliation(s)
- Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
|
18
|
Abstract
Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome.
Collapse
Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
|
19
|
Boisseau CL, Rasmussen SA. Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods. Contemp Clin Trials 2018; 65:157-163. [PMID: 29306047 PMCID: PMC5803458 DOI: 10.1016/j.cct.2017.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is chronic psychiatric disorder associated with high rates of functional impairment and decreased quality of life. Although serotonin reuptake inhibitors have demonstrated efficacy in the treatment of OCD, little data is available to guide clinicians on how to manage these medications long-term. Cognitive-behavioral approaches provide a promising avenue for helping OCD patients discontinue maintenance SRIs while minimizing the potential for symptom worsening. This manuscript describes the rationale and methods for pilot feasibility study designed to a unified, cognitive-behavioral strategy for discontinuing long-term SRIs in OCD. The aims of the study are (1) to evaluate the feasibility and acceptability of research procedures and interventions, (2) to test the efficacy of this treatment relative to an enhanced control condition and (3) to investigate the role of distress tolerance in both taper completion and clinical outcome. Our central aim is to investigate whether this approach improves discontinue outcomes relative to an enhanced control condition. Identifying optimal long-term treatment strategies for this population is needed to guide clinicians managing this often-chronic disorder.
Collapse
Affiliation(s)
- Christina L Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States.
| | - Steven A Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| |
Collapse
|
|
20
|
Katz D, Rector NA, Laposa JM. The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1334087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Danielle Katz
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A. Rector
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Judith M. Laposa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
|
21
|
Woon LSC, Kanapathy A, Zakaria H, Alfonso CA. An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder. Psychodyn Psychiatry 2017; 45:237-257. [PMID: 28590207 DOI: 10.1521/pdps.2017.45.2.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.
Collapse
Affiliation(s)
- Luke Sy-Cherng Woon
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Anita Kanapathy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Hazli Zakaria
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - César A Alfonso
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Columbia University Medical Center Department of Psychiatry, New York
| |
Collapse
|
|
22
|
Scheveneels S, Boddez Y, Vervliet B, Hermans D. The validity of laboratory-based treatment research: Bridging the gap between fear extinction and exposure treatment. Behav Res Ther 2016; 86:87-94. [DOI: 10.1016/j.brat.2016.08.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 01/26/2023]
|
|
23
|
Wu MS, McGuire JF, Horng B, Storch EA. Further psychometric properties of the Yale-Brown Obsessive Compulsive Scale - Second Edition. Compr Psychiatry 2016; 66:96-103. [PMID: 26995242 DOI: 10.1016/j.comppsych.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 01/04/2023] Open
Abstract
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a widely used clinician-rated measure for assessing obsessive-compulsive symptoms. Although numerous studies have supported its reliability and validity, improved phenomenological understanding of obsessive-compulsive disorder (OCD) suggests the need for modifications to item content, structure, and scoring. Consequently, the Yale-Brown Obsessive Compulsive Scale - Second Edition (Y-BOCS-II) was developed. While the Y-BOCS-II shows initial promise, minimal data exist in examining the psychometric properties of the Y-BOCS-II English version. In response, the Y-BOCS-II was administered to 61 adult patients with a principal diagnosis of obsessive-compulsive disorder. The internal consistency for the scores on the Obsession Severity (α=.83), Compulsion Severity (α=.75), and Total Severity (α=.86) scales were acceptable to good. The inter-rater reliability for the severity scale scores was excellent (ICC=.97-99) and the test-retest reliability was acceptable (r=.64-81). Strong convergent validity was observed between the Y-BOCS-II Total Severity scale and other measures of obsessive-compulsive symptom severity and related impairment. Good divergent validity was supported by non-significant correlations between the Total Severity score and measures of anxiety and impulsiveness, though a moderate correlation was observed with depressive symptoms. Collectively, the Y-BOCS-II generally possesses sound psychometric properties and appears to be a viable alternative to the original Y-BOCS.
Collapse
Affiliation(s)
- Monica S Wu
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Joseph F McGuire
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Betty Horng
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Health Management and Policy, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA; All Children's Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA
| |
Collapse
|
|
24
|
Yang XY, Sun J, Luo J, Zhong ZX, Li P, Yao SM, Xiong HF, Huang FF, Li ZJ. Regional homogeneity of spontaneous brain activity in adult patients with obsessive-compulsive disorder before and after cognitive behavioural therapy. J Affect Disord 2015; 188:243-251. [PMID: 26378734 DOI: 10.1016/j.jad.2015.07.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). Several neuroimaging studies have explored alterations of brain function in OCD patients as they performed tasks after CBT. However, the effects of CBT on the neural activityin OCD during rest remain unknown. Therefore, we investigated changes in regional homogeneity (ReHo) in OCD patients before and after CBT. METHODS Twenty-two OCD patients and 22 well-matched healthy controls participated in the resting-state functional magnetic resonance imaging scans. We compared differences in ReHo between the OCD and control groups before treatment and investigated the changes of ReHo in 17 OCD patients who responded to CBT. RESULTS Compared to healthy controls, OCD patients exhibited higher ReHo in the right orbitofrontal cortex (OFC), bilateral middle frontal cortex, right precuneus, left cerebellum, and vermis, as well as lower ReHo in the bilateral caudate, right calcarine, right posterior cingulate cortex, and right middle temporal cortex. Along with the clinical improvement in OCD patients after CBT, we found decreased ReHo in the right OFC, bilateral middle frontal cortex, left cerebellum and vermis, and increased ReHo in the left caudate. Improvement of OCD symptoms was significantly correlated with the changed ReHo in the right OFC and left cerebellum. CONCLUSIONS Although these findings are preliminary and need to be replicated in larger samples, they indicate the presence of abnormal spontaneous brain activity of the prefrontal-striatal-cerebellar circuit in OCD patients, and provide evidence that CBT can selectively modulate the spontaneous brain activity of this circuit in OCD patients.
Collapse
Affiliation(s)
- Xiang-Yun Yang
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Jing Sun
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Australia.
| | - Jia Luo
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Zhao-Xi Zhong
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Ping Li
- Department of Psychiatry, Qiqihaer Medical University, Qiqihaer, Heilongjiang, China.
| | - Shu-Min Yao
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Hong-Fang Xiong
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Fang-Fang Huang
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| | - Zhan-Jiang Li
- Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
| |
Collapse
|
|
25
|
Abstract
Unlike obsessive compulsive personality traits or occasional repetitive habits, obsessive compulsive disorder can be highly distressing and associated with significant disability. Treatment should always be offered. Psychological interventions and selective serotonin reuptake inhibitors are first-line treatments for obsessive compulsive disorder. Patients with obsessive compulsive disorder respond to selective serotonin reuptake inhibitors at a slower rate than those with depression. The dose of a selective serotonin reuptake inhibitor can be increased at two-week intervals depending on the patient's response. Aim for doses in the higher therapeutic range. Improvements from treatment usually plateau at 12 weeks. Successful treatment should continue for at least 12 months. There is a significant risk of relapse when treatment is stopped.
Collapse
|
|
26
|
O’Neill J, Feusner JD. Cognitive-behavioral therapy for obsessive-compulsive disorder: access to treatment, prediction of long-term outcome with neuroimaging. Psychol Res Behav Manag 2015; 8:211-23. [PMID: 26229514 PMCID: PMC4516342 DOI: 10.2147/prbm.s75106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This article reviews issues related to a major challenge to the field for obsessive-compulsive disorder (OCD): improving access to cognitive-behavioral therapy (CBT). Patient-related barriers to access include the stigma of OCD and reluctance to take on the demands of CBT. Patient-external factors include the shortage of trained CBT therapists and the high costs of CBT. The second half of the review focuses on one partial, yet plausible aid to improve access - prediction of long-term response to CBT, particularly using neuroimaging methods. Recent pilot data are presented revealing a potential for pretreatment resting-state functional magnetic resonance imaging and magnetic resonance spectroscopy of the brain to forecast OCD symptom severity up to 1 year after completing CBT.
Collapse
Affiliation(s)
- Joseph O’Neill
- Division of Child Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Jamie D Feusner
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
|
27
|
Switching to zebrafish neurobehavioral models: The obsessive–compulsive disorder paradigm. Eur J Pharmacol 2015; 759:142-50. [DOI: 10.1016/j.ejphar.2015.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/29/2015] [Accepted: 03/12/2015] [Indexed: 12/15/2022]
|
|
28
|
Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res 2015; 227:104-13. [PMID: 25937054 DOI: 10.1016/j.psychres.2015.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022]
Abstract
Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy (CT), has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
Collapse
|
|
29
|
McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res 2015; 225:236-46. [PMID: 25613661 DOI: 10.1016/j.psychres.2014.11.058] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
Abstract
Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy, has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
Collapse
Affiliation(s)
| | | | | | - Sabine Wilhelm
- Harvard University & Massachusetts General Hospital, Boston, MA, USA
| | - Dan J Stein
- University of Cape Town, Cape Town, South Africa
| | | | | | - David Veale
- NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, King׳s College London, UK
| |
Collapse
|
|
30
|
Feusner JD, Moody T, Lai TM, Sheen C, Khalsa S, Brown J, Levitt J, Alger J, O'Neill J. Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive-compulsive disorder. Front Psychiatry 2015; 6:74. [PMID: 26042054 PMCID: PMC4438601 DOI: 10.3389/fpsyt.2015.00074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Intensive cognitive-behavioral therapy (CBT) can effectively reduce symptoms in obsessive-compulsive disorder (OCD). However, many relapse after treatment. Few studies have investigated biological markers predictive of follow-up clinical status. The objective was to determine if brain network connectivity patterns prior to intensive CBT predict worsening of clinical symptoms during follow-up. METHODS We acquired resting-state functional magnetic resonance imaging data from 17 adults with OCD prior to and following 4 weeks of intensive CBT. Functional connectivity data were analyzed to yield graph-theory metrics. We examined the relationship between pre-treatment connectome properties and OCD clinical symptoms before and after treatment and during a 12-month follow-up period. RESULTS Mean OCD symptom decrease was 40.4 ± 16.4% pre- to post-treatment (64.7% responded; 58.8% remitted), but 35.3% experienced clinically significant worsening during follow-up. From pre- to post-treatment, small-worldness and clustering coefficient significantly increased. Decreases in modularity correlated with decreases in OCD symptoms. Higher pre-treatment small-world connectivity was significantly associated with worsening of OCD symptoms during the follow-up period. Psychometric and neurocognitive measures pre- and post-treatment were not significant predictors. CONCLUSION This is the first graph-theory connectivity study of the effects of CBT in OCD, and the first to test associations with follow-up clinical status. Results show functional network efficiency as a biomarker of CBT response and relapse in OCD. CBT increases network efficiency as it alleviates symptoms in most patients, but those entering therapy with already high network efficiency are at greater risk of relapse. Results have potential clinical implications for treatment selection.
Collapse
Affiliation(s)
- Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Teena Moody
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Tsz Man Lai
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Courtney Sheen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Sahib Khalsa
- Laureate Institute for Brain Research , Tulsa, OK , USA ; The University of Tulsa , Tulsa, OK , USA
| | - Jesse Brown
- Department of Neurology, University of California San Francisco , San Francisco, CA , USA
| | - Jennifer Levitt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Jeffry Alger
- Department of Neurology, University of California Los Angeles , Los Angeles, CA , USA
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| |
Collapse
|
|
31
|
Mantione M, Nieman DH, Figee M, Denys D. Cognitive-behavioural therapy augments the effects of deep brain stimulation in obsessive-compulsive disorder. Psychol Med 2014; 44:3515-3522. [PMID: 25065708 DOI: 10.1017/s0033291714000956] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising new treatment for patients with treatment-refractory obsessive-compulsive disorder (OCD). However, since most DBS patients only show a partial response, the treatment still needs to be improved. In this study we hypothesized that cognitive-behavioural therapy (CBT) could optimize the post-operative management in DBS and we evaluated the efficacy of CBT as augmentation to DBS targeted at the nucleus accumbens. METHOD A total of 16 patients with treatment-refractory OCD were treated with DBS targeted at the nucleus accumbens. After stabilization of decline in OCD symptoms, a standardized 24-week CBT treatment programme was added to DBS in an open-phase trial of 8 months. Changes in obsessive-compulsive, anxiety and depressive symptoms were evaluated using the Yale-Brown Obsessive Compulsive Scale, Hamilton Anxiety Scale and Hamilton Rating Scale for Depression. RESULTS Following the addition of CBT to DBS, a significant decrease in obsessive-compulsive symptoms was observed, but not in anxiety and depressive symptoms. In a subsequent double-blind phase, in which stimulation was discontinued, OCD symptoms returned to baseline (relapse) and anxiety and depressive symptoms worsened (rebound) compared with baseline. CONCLUSIONS The results of this explorative study suggest that a combined treatment of accumbens DBS and CBT may be optimal for improving obsessive-compulsive symptoms in treatment-refractory OCD. However, a subsequent randomized controlled trial is necessary to draw firm conclusions. It seems that DBS results in affective changes that may be required to enable response prevention in CBT. This may indicate that DBS and CBT act as two complementary treatments.
Collapse
Affiliation(s)
- M Mantione
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D H Nieman
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M Figee
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| |
Collapse
|
|
32
|
Belus JM, Baucom DH, Abramowitz JS. The effect of a couple-based treatment for OCD on intimate partners. J Behav Ther Exp Psychiatry 2014; 45:484-8. [PMID: 25086352 DOI: 10.1016/j.jbtep.2014.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES This study investigated the effect of a couple-based cognitive behavioral therapy (CBT) for the treatment of obsessive-compulsive disorder (OCD) on the intimate partners of patients. Previous research has shown this intervention to be efficacious in reducing OCD symptoms and comorbidities in patients. METHOD In an open-treatment trial, 16 couples completed the 16-session manualized treatment, and were followed up 6- and 12-months post-treatment. RESULTS Multilevel modeling analyses were conducted to examine change over time, and results indicated that relative to baseline, partners showed improvements in relationship functioning, communication, and criticalness in the short-term, and maintained their gains in communication skills over the long-term. LIMITATIONS The non-controlled design and small sample size limit the certainty of the study's findings. CONCLUSIONS Overall, this investigation offers preliminary evidence that including intimate partners in couple-based CBT for OCD has no negative effects on partners, and in fact, can provide them with residual positive effects.
Collapse
Affiliation(s)
- Jennifer M Belus
- Department of Psychology, University of North Carolina at Chapel Hill, USA.
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill, USA
| | | |
Collapse
|
|
33
|
Külz AK, Landmann S, Cludius B, Hottenrott B, Rose N, Heidenreich T, Hertenstein E, Voderholzer U, Moritz S. Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. BMC Psychiatry 2014; 14:314. [PMID: 25403813 PMCID: PMC4239327 DOI: 10.1186/s12888-014-0314-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/24/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges. METHODS/DESIGN This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task. DISCUSSION The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD. TRIAL REGISTRATION German Clinical Trials Register DRKS00004525 . Registered 19 March 2013.
Collapse
Affiliation(s)
- Anne Katrin Külz
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Sarah Landmann
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Nina Rose
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Elisabeth Hertenstein
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
|
34
|
Graham BM, Callaghan BL, Richardson R. Bridging the gap: Lessons we have learnt from the merging of psychology and psychiatry for the optimisation of treatments for emotional disorders. Behav Res Ther 2014; 62:3-16. [DOI: 10.1016/j.brat.2014.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 02/08/2023]
|
|
35
|
Holmes EA, Craske MG, Graybiel AM. Psychological treatments: A call for mental-health science. Nature 2014; 511:287-9. [PMID: 25030152 DOI: 10.1038/511287a] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emily A Holmes
- Medical Research Council Cognition & Brain Sciences Unit, Cambridge, UK, and in the Department for Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Ann M Graybiel
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| |
Collapse
|
|
36
|
Arumugham SS, Reddy YCJ. Commonly asked questions in the treatment of obsessive-compulsive disorder. Expert Rev Neurother 2013; 14:151-63. [PMID: 24372473 DOI: 10.1586/14737175.2014.874287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common and often a highly disabling condition that was considered untreatable before the 1960s. The advent of serotonin reuptake inhibitors and exposure and response prevention revolutionized the treatment of OCD. Although they are still the first line treatments for OCD, new treatments like augmentation strategies, brain stimulation techniques, psychosurgery, newer forms of psychotherapy (like cognitive therapy, acceptance and commitment therapy) have been added to the armamentarium. With the available treatment strategies, many patients can achieve at least partial remission of symptoms. Nevertheless, the plethora of information gives rise to many questions on their application for practicing clinicians. We provide evidence-based responses to these questions and suggest a broad guideline for treatment of OCD.
Collapse
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, Obsessive-Compulsive Disorder (OCD) Clinic, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India-560029
| | | |
Collapse
|
|
37
|
Abramowitz JS, Baucom DH, Boeding S, Wheaton MG, Pukay-Martin ND, Fabricant LE, Paprocki C, Fischer MS. Treating obsessive-compulsive disorder in intimate relationships: a pilot study of couple-based cognitive-behavior therapy. Behav Ther 2013; 44:395-407. [PMID: 23768667 DOI: 10.1016/j.beth.2013.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 02/04/2013] [Accepted: 02/22/2013] [Indexed: 11/19/2022]
Abstract
Although cognitive-behavioral therapy (CBT) involving exposure and response prevention (ERP) is an established treatment for obsessive-compulsive disorder (OCD), not all patients respond optimally, and some show relapse upon discontinuation. Research suggests that for OCD patients in close relationships, targeting relationship dynamics enhances the effects of CBT. In the present study, we developed and pilot tested a 16-session couple-based CBT program for patients with OCD and their romantic partners. This program included (a) partner-assisted ERP, (b) techniques targeting maladaptive relationship patterns focal to OCD (e.g., symptom accommodation), and (c) techniques targeting non OCD-related relationship stressors. OCD, related symptoms, and relationship functioning were assessed at baseline, immediately following treatment (posttest), and at 6- and 12-month follow-up. At posttest, substantial improvements in OCD symptoms, relationship functioning, and depression were observed. Improvements in OCD symptoms were maintained up to 1year. Results are compared to findings from studies of individual CBT for OCD and discussed in terms of the importance of addressing interpersonal processes that maintain OCD symptoms.
Collapse
|
|
38
|
Foa EB, Simpson HB, Liebowitz MR, Powers MB, Rosenfield D, Cahill SP, Campeas R, Franklin M, Hahn CG, Hembree EA, Huppert JD, Schmidt AB, Vermes D, Williams MT. Six-month follow-up of a randomized controlled trial augmenting serotonin reuptake inhibitor treatment with exposure and ritual prevention for obsessive-compulsive disorder. J Clin Psychiatry 2013; 74:464-9. [PMID: 23759449 PMCID: PMC3977336 DOI: 10.4088/jcp.12m08017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/25/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This article describes the long-term effects of augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder (OCD). METHOD Between November 2000 and November 2006, 111 OCD patients from 2 academic outpatient centers with partial SRI response were randomized to the addition of exposure and ritual prevention or stress management training, delivered twice weekly for 8 weeks (acute phase); 108 began treatment. Responders (38 of 52 in the exposure and ritual prevention condition, 11 of 52 in the stress management training condition) entered a 24-week maintenance phase. The Yale-Brown Obsessive Compulsive Scale (YBOCS) was the primary outcome measure. RESULTS After 24 weeks, patients randomized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes (mean YBOCS scores of 14.69 and 21.37, respectively; t = 2.88, P = .005), higher response rates (decrease in YBOCS scores ≥ 25%: 40.7% vs 9.3%, Fisher exact test P < .001), and higher rates of excellent response (YBOCS score ≤ 12: 24.1% vs 5.6%, Fisher exact test P = .01). During the maintenance phase, the slope of change in YBOCS scores was not significant in either condition (all P values ≥ .55), with no difference between exposure and ritual prevention and stress management training (P > .74). Better outcome was associated with baseline variables: lower YBOCS scores, higher quality of life, fewer comorbid Axis I diagnoses, and male sex. CONCLUSIONS Augmenting SRIs with exposure and ritual prevention versus stress management training leads to better outcome after acute treatment and 24 weeks later. Maintenance outcome, however, was primarily a function of OCD severity at entrance. Greater improvement during the acute phase influences how well patients maintain their gains, regardless of treatment condition.
Collapse
|
|
39
|
PONNIAH K, MAGIATI I, HOLLON SD. An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults. J Obsessive Compuls Relat Disord 2013; 2:207-218. [PMID: 23888284 PMCID: PMC3718079 DOI: 10.1016/j.jocrd.2013.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a review to provide an update on the efficacy of psychological treatments for OCD in general and with regard to specific symptom presentations. The PubMed and PsycINFO databases were searched for randomized controlled trials (RCTs) published up to mid February 2012. Forty-five such studies were identified. Exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT) were found to be efficacious and specific for OCD. More purely cognitive interventions that did not include ERP or behavioral experiments were found to be possibly efficacious, as were Acceptance and Commitment Therapy, Motivational Interviewing as an adjunct to the established treatments, Eye Movement Desensitization and Reprocessing, and Satiation Therapy. There was little support for Stress Management or Psychodynamic Therapy. Although the majority of the studies recruited mixed or unspecified samples of patients and did not test for moderation, CBT was efficacious for obsessional patients who lacked overt rituals. One more purely cognitive intervention named Danger Ideation Reduction Therapy was found to be possibly efficacious for patients with contamination obsessions and washing compulsions. Although ERP and CBT are the best established psychological treatments for OCD, further research is needed to help elucidate which treatments are most effective for different OCD presentations.
Collapse
Affiliation(s)
- Kathryn PONNIAH
- Department of Psychology, National University of Singapore, Singapore
| | - Iliana MAGIATI
- Department of Psychology, National University of Singapore, Singapore
| | - Steven D. HOLLON
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
|
40
|
Lack CW. Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World J Psychiatry 2012; 2:86-90. [PMID: 24175173 PMCID: PMC3782190 DOI: 10.5498/wjp.v2.i6.86] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 09/14/2012] [Accepted: 09/21/2012] [Indexed: 02/05/2023] Open
Abstract
Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.
Collapse
Affiliation(s)
- Caleb W Lack
- Caleb W Lack, Department of Psychology, University of Central Oklahoma, Edmond, OK 73034, United States
| |
Collapse
|
|
41
|
Norberg MM, Gilliam CM, Villavicencio A, Pearlson GD, Tolin DF. D-Cycloserine for Treatment Nonresponders With Obsessive-Compulsive Disorder: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
42
|
Steinglass J, Albano AM, Simpson HB, Schebendach J, Attia E, Attia E. Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series. Int J Eat Disord 2012; 45:615-21. [PMID: 21541979 PMCID: PMC3151474 DOI: 10.1002/eat.20936] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating-related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and obsessive compulsive disorder, namely exposure therapy and response prevention. METHOD We developed a brief treatment intervention for AN (AN-EXRP) and evaluated its effects in an open series of nine individuals with AN towards the end of acute weight restoration. We focused on eating behavior as the primary outcome, as it is related both to anxiety and to longer term course. RESULTS Change in anxiety with AN-EXRP was associated with greater caloric intake. DISCUSSION These findings support the anxiety-centered model of AN and suggest the potential utility of further developing this treatment approach.
Collapse
Affiliation(s)
- Joanna Steinglass
- Department of Psychiatry, Division of Clinical Therapeutics, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
|
43
|
Graham BM, Langton JM, Richardson R. Pharmacological enhancement of fear reduction: preclinical models. Br J Pharmacol 2012; 164:1230-47. [PMID: 21175588 DOI: 10.1111/j.1476-5381.2010.01175.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Anxiety disorders have a high prevalence, and despite the substantial advances in the psychological treatment of anxiety, relapse is still a common problem. One approach to improving existing psychological treatments for anxiety has been to develop pharmacological agents that can be used to enhance the processes underlying exposure therapy, which is the most commonly used and empirically validated psychological treatment for anxiety during which individuals are taught to appropriately inhibit fear. Animal models of exposure therapy, particularly fear extinction, have proved to be a very useful way of examining the neural and molecular correlates of fear inhibition, which has in turn led to the identification of numerous drugs that enhance these processes in rats. Several of these drugs have subsequently been tested as novel pharmacological adjuncts to exposure therapy in humans with a range of anxiety disorders. The purpose of this review is to outline the key animal models of exposure therapy and to describe how these have been used to develop potential pharmacological adjuncts for anxiety disorders. Drugs that are currently in clinical use, as well as those currently in the preclinical stages of investigation, are described.
Collapse
|
|
44
|
Affiliation(s)
- Martin E. Franklin
- Child/Adolescent OCD, Tics, Trichotillomania and Anxiety Group, Department of Psychiatry, University of Pennsylvania School of Medicine, and Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104
| | - Edna B. Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104;
| |
Collapse
|
|
45
|
Albelda N, Joel D. Animal models of obsessive-compulsive disorder: exploring pharmacology and neural substrates. Neurosci Biobehav Rev 2011; 36:47-63. [PMID: 21527287 DOI: 10.1016/j.neubiorev.2011.04.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/05/2011] [Accepted: 04/08/2011] [Indexed: 01/07/2023]
Abstract
During the last 30 years there have been many attempts to develop animal models of obsessive-compulsive disorder (OCD). Most models have not been studied further following the original publication, and in the past few years, most papers present studies employing a few established animal models, exploring the neural basis of compulsive behavior and developing new treatment strategies. Here we summarize findings from the five most studied animal models of OCD: 8-OHDPAT (8-hydroxy-2-(di-n-propylamino)-tetralin hydrobromide) induced decreased alternation, quinpirole-induced compulsive checking, marble burying, signal attenuation and spontaneous stereotypy in deer mice. We evaluate each model's face validity, derived from similarity between the behavior in the model and the specific symptoms of the human condition, predictive validity, derived from similarity in response to treatment (pharmacological or other), and construct validity, derived from similarity in the mechanism (physiological or psychological) that induces behavioral symptoms and in the neural systems involved. We present ideas regarding future clinical research based on each model's findings, and on this basis, also emphasize possible new approaches for the treatment of OCD.
Collapse
Affiliation(s)
- Noa Albelda
- Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel
| | | |
Collapse
|
|
46
|
Abstract
OBJECTIVE The aim of this paper was to examine the place of anxiety disorders in contemporary psychiatry, its origins, and possible implications for the future of psychiatry. CONCLUSIONS Several factors have led psychiatry away from neuroses and anxiety disorders and towards depression as a social paradigm of distress: a perception that anxiety disorders have relatively little relevance, the decline of psychoanalysis and rise of biological psychiatry, the downfall of the benzodiazepines and a failure to replace them with better anxiolytics, and the development of newer antidepressants. The subsequent imposition of the rigid conceptual dichotomy between depression and anxiety strengthened a notion that the focus of psychiatry should be on the 'depression side' of this divide. Having promoted cognitive-behavioural therapy as the best treatment for anxiety disorders, clinical psychologists have largely 'taken over' the anxiety disorders from psychiatrists. It is suggested that psychiatrists' surrender of the anxiety disorders may have negative consequences for the future of psychiatry.
Collapse
Affiliation(s)
- Vladan Starcevic
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
|
47
|
Abstract
Until the mid-1960s, obsessive-compulsive disorder (OCD) was considered to be treatment-resistant, as both psychodynamic psychotherapy and medication had been unsuccessful in significantly reducing OCD symptoms. The first real breakthrough came in 1966 with the introduction of exposure and ritual prevention. This paper will discuss the cognitive behavioral conceptualizations that influenced the development of cognitive behavioral treatments for OCD. There will be a brief discussion of the use of psychodynamic psychotherapy and early behavioral therapy, neither of which produced successful outcomes with OCD. The main part of the paper will be devoted to current cognitive behavioral therapy (CBT) with an emphasis on variants of exposure and ritual or response prevention (EX/RP) treatments, the therapy that has shown the most empirical evidence of its efficacy.
Collapse
Affiliation(s)
- Edna B Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
| |
Collapse
|
|
48
|
High but not low frequency stimulation of both the globus pallidus and the entopeduncular nucleus reduces 'compulsive' lever-pressing in rats. Behav Brain Res 2010; 216:84-93. [PMID: 20654653 DOI: 10.1016/j.bbr.2010.07.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 11/21/2022]
Abstract
The anti-compulsive effects of high and low frequency stimulation (LFS, HFS) of the entopeduncular nucleus and globus pallidus (the rat's equivalent, respectively, of the primate's internal and external segments of the globus pallidus) were assessed in the signal attenuation rat model of obsessive-compulsive disorder (OCD). HFS, but not LFS, of the two nuclei exerted an anti-compulsive effect, suggesting that HFS of either segment of the globus pallidus may provide an additional therapeutic strategy for OCD.
Collapse
|
|
49
|
Phillips KA, Stein DJ, Rauch SL, Hollander E, Fallon BA, Barsky A, Fineberg N, Mataix-Cols D, Ferrão YA, Saxena S, Wilhelm S, Kelly MM, Clark LA, Pinto A, Bienvenu OJ, Farrow J, Leckman J. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010; 27:528-55. [PMID: 20533367 PMCID: PMC3985410 DOI: 10.1002/da.20705] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.
Collapse
|
|
50
|
Stein DJ, Denys D, Gloster AT, Hollander E, Leckman JF, Rauch SL, Phillips KA. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin North Am 2009; 32:665-85. [PMID: 19716996 DOI: 10.1016/j.psc.2009.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews current issues in the diagnosis and treatment of obsessive-compulsive disorder (OCD). The introduction of the selective serotonin reuptake inhibitors and of cognitive-behavioral therapy were significant advances for treating OCD. Nevertheless, there is a need to improve awareness of OCD and its management, and to develop novel approaches to treatment-refractory patients. Although the diagnostic criteria for OCD have remained unchanged for some time, there are several areas where potential modification may be useful. There is a growing evidence base on OCD symptom dimensions and subtyping, and it is timely to consider incorporating some of these emerging data into diagnostic classification systems.
Collapse
Affiliation(s)
- Dan J Stein
- Deparment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | | | | | | | | | | | | |
Collapse
|