Disorders - Obsessive Compulsive Disorder
Melin, K., Skarphedinsson, G., Thomsen, P. H., Weidle, B., Torp, N. C., Valderhaug, R., etal.
Objective: This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. Method(s): This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. Result(s): Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. Conclusion(s): The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. Clinical trial registration information: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. Copyright © 2019 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry., 58(2) : 244-253
- Year: 2019
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Sun, M., Rith-Najarian, L. R., Williamson, T. J., Chorpita, B. F.
Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 48(Supplement1) : S269-S283
- Year: 2019
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Jacoby, R. J., Abramowitz, J. S., Blakey, S. M., Reuman, L.
Background and objectives: Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term outcomes relative to traditional gradual (hierarchical) exposure Methods: Adults (N = 40) with a moderately distressing unacceptable obsessional thought were randomly assigned in parallel to four twice-weekly sessions of: (a) gradual exposure (EXP-G; n = 19) emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V; n = 21) emphasizing variability in exposure intensity Results: There were no significant differences in pre to post changes between groups using self-report, interview, or behavioral outcomes (as evaluated by an independent assessor blind to treatment condition). Group comparisons at 3-month follow-up did not reach statistical significance but were moderate in magnitude. Specifically, as measured by clinical interview (the Yale-Brown Obsessive-Compulsive Scale; primary outcome) and self-report, individuals in the EXP-G group maintained gains at 3-month follow-up, while the EXP-V group continued to improve. Treatment expectancies and satisfaction were comparable for both groups. Five participants withdrew from the EXP-G condition, and none withdrew from the EXP-V condition. In contrast to previous studies, variability in subjective and physiological fear during exposure did not predict outcomes Limitations: The study employed an analogue sample with moderate unacceptable obsessions, and results should be replicated in clinical samples Conclusion(s): Variable exposure warrants future study to understand the mechanisms, moderators, and implications of this novel approach Copyright © 2019 Elsevier Ltd
Journal of Behavior Therapy and Experimental Psychiatry, 64 : 54-63
- Year: 2019
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other service delivery and improvement interventions
Shabani, M. J., Mohsenabadi, H., Omidi, A., Lee, E. B., Twohig, M. P., Ahmadvand, A., Zanjani, Z.
Conducted in Iran, participants included 69 adolescents with obsessive-compulsive disorder (OCD) who were on a stable selective serotonin reuptake inhibitor (SSRI) dose and were randomly assigned to one of three conditions: group acceptance and commitment therapy (ACT)+SSRI, group cognitive behavioral therapy (CBT)+SSRI, or continued SSRI treatment. Assessment occurred at pre-, post-treatment, and three-month follow-up and included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Children's Depression Inventory (CDI), Avoidance and Fusion Questionnaire for Youth (AFQ-8), Valued Living Questionnaire (VLQ), and Child and Adolescent Mindfulness Measure (CAMM). ACT + SSRI and CBT + SSRI conditions demonstrated significant reductions in OCD severity that were maintained at follow-up compared to the continued SSRI condition. All conditions demonstrated significant reductions in depression that were maintained at follow-up. The ACT + SSRI condition demonstrated significant improvement in psychological flexibility, mindfulness, and valued living that were maintained at follow-up compared to the CBT + SSRI and continued SSRI conditions. Findings indicate that ACT + SSRI is comparably effective as CBT + SSRI at treating adolescent OCD. However, ACT + SSRI appears to differ from CBT + SSRI on changes in psychological flexibility, mindfulness, and valued living, indicating potential differences in mechanism of change. Copyright © 2019 Elsevier Inc.
Journal of Obsessive-Compulsive and Related Disorders, 22 (no pagination)(100440) :
- Year: 2019
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Acceptance & commitment therapy (ACT)
Gowda, S. M., Narayanaswamy, J. C., Hazari, N., Bose, A., Chhabra, H., Balachander, S., Bhaskarapillai, B., Shivakumar, V., Venkatasubramanian, G., Reddy, Y. C. J.
Background: A significant proportion of obsessive compulsive disorder (OCD) patients do not respond to specific serotonin reuptake inhibitors (SSRIs). There is a need to evaluate novel treatment options for OCD. Objective(s): In this double blinded, randomized, sham controlled study, we investigated the efficacy of add-on transcranial direct current stimulation (tDCS) in reducing the symptoms in SSRI-resistant OCD patients by employing anodal pre-supplementary motor area (pre-SMA) stimulation. Method(s): Twenty-five patients with DSM-IV OCD having persistent symptoms despite adequate and stable treatment with at least one SSRI were randomly allocated to receive 20 min of verum (active) 2-mA tDCS or sham stimulation twice daily on 5 consecutive days [anode over Pre-SMA; cathode over right supra-orbital area]. Response to treatment was defined as at least 35% reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score along with a Clinical Global Impression - Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved). Result(s): The response rate was significantly greater in the verum tDCS(4 out of 12) compared to sham-tDCS (0 out of 13) [Fisher's exact test, p = 0.04]. Repeated measures analysis of variance with tDCS type (verum vs. sham) as between subjects factor showed that there was a significant tDCS-type X time-point interaction with significantly greater reduction of YBOCS total score [F (1,22) = 4.95,p = 0.04,partial-eta2 = 0.18] in verum-tDCS group. Conclusion(s): The results of this RCT suggest that tDCS may be effective in treating SSRI-resistant OCD. Future studies should examine the efficacy in larger samples of OCD and explore other potential target regions using randomized sham-controlled designs, in addition to examining the sustainability of the beneficial effects. Trial registration: Clinical Trials Registry India (http://ctri.nic.in/Clinicaltrials/login.php): Registration Number- CTRI/2016/04/006837). Copyright © 2019 Elsevier Inc.
Brain Stimulation, 12(4) : 922-929
- Year: 2019
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Zheng, H.
More effective, tolerable interventions for treatment-refractory obsessive-compulsive disorder (OCD) are needed. Preliminary findings encourage optimism that methylphenidate augmentation may be of benefit in the treatment of OCD. To test modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) a safe and effective add-on therapy for refractory OCD, a pilot randomized, placebo-controlled, double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor (SRI) treatment-refractory OCD and receiving a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. Data were analyzed in the intention-to-treat sample. All subjects were randomized into two parallel groups to receive fluvoxamine (250 mg daily) plus MPH-ER (36 mg daily) or fluvoxamine (250 mg daily) plus identical placebo tablets under double-blind conditions and followed for 8 weeks. Forty-four patients (29 [66%] men), with a mean (SD) age of 24.7 (6) years participated; with a mean (SD) duration of episode 5.7 (3) were randomized and forty-one finished the trial. In the intention-to-treat analysis, the improvement in the Y-BOCS total score and Y-BOCS obsession subscale score was more prominent in the fluvoxamine and MPH-ER group compared with those receiving placebo (P <.001). Additionally, cumulative response rates were higher in the MPH-ER vs placebo groups (59% vs 5%; P <.001). MPH-ER was well tolerated; No subjects dropped out due to side effects. In summary, combined treatment with MPH-ER demonstrated an enhanced clinical rate of response compared to placebo. Further trials should examine MPH-ER efficacy in a larger sample Copyright © 2018 Elsevier Ltd
European Neuropsychopharmacology, 29(3) : 397-404
- Year: 2019
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Other biological interventions
Staugaard, C. F., Uhre, V., Lonfeldt, N., Pretzmann, L., Vangkilde, S., Plessen, K., Pagsberg, K.
Objective: To assess the effect of cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Method(s): We systematically reviewed data from randomized trials with children and adolescents with OCD, comparing CBT with 1) no intervention (e.g., wait list); 2) treatment as usual (or similar terms); 3) pharmacological treatments; or 4) alternative psychotherapeutic approaches. On July 28th, 2017, we conducted a systematic literature search, which yielded 12 eligible trials. Data from the trials were grouped into three comparisons: CBT vs. no intervention (n = 7), CBT vs. pharmacological intervention (n = 3), CBT vs. relaxation therapy (n = 3). We assessed the effect on symptom severity measured with the Children's Yale-Brown Obsessive Compulsive Scale. To evaluate the quality of the trials, two independent investigators assessed risk of bias within seven domains, following the guidelines of The Cochrane Collaboration. For further details, see our protocol on PROSPERO (CRD42017079118). Result(s): The overall results indicate that in pediatric OCD, CBT is more favorable than no intervention (Z = 5.29, p<0. 00001), and relaxation training (Z = 7.22, p<0.00001), while no significant difference was found, comparing CBT to pharmacological treatment (Z = 0.05, p = 0.96). However, all included trials had a high risk of bias, not only owing to the nature of psychotherapeutic interventions, which makes blinding of participants and treatment providers effectively impossible. Conclusion(s): The systematic review indicates that CBT is more favorable than no intervention and relaxation training, and as effective as pharmacological treatment, for pediatric OCD. However, the quality of the evidence is low, and future trials with low risk of bias are needed.
Early Intervention in Psychiatry, 12 (Supplement 1) : 166
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Relaxation
Rouel, M., Smith, E.
Attentional biases, particularly difficulty disengaging, have been found in contamination obsessive-compulsive disorder (OCD) and may be a maintaining factor. Attentional bias modification (ABM) may reduce this bias and avoidance behavior. This study examined attentional biases in 54 individuals with contamination OCD symptomatology and whether ABM reduces biases and symptoms. Participants completed one 30 min session of either ABM training or a control task and a spatial cueing task before and after to assess attentional bias. Questionnaires and behavioral tasks were also completed. Participants returned for a follow up 1 month later. As expected, there was evidence of difficulty disengaging from threats directly and indirectly associated with disease. Attention training led to a reduction in this bias, which was maintained for 1 month. However, there was no improvement in avoidance or contamination fear on a behavioral task, contamination OCD symptoms, safety behaviors and anxiety. Implications for treatment of OCD are discussed. Copyright © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Cognitive Therapy and Research, 42(5) : 686-698
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Ching, T. H. W., Williams, M. T.
There is little research on treating symptoms of sexual orientation-obsessive-compulsive disorder (SO-OCD). Semantic networks represent a new cognitive approach for understanding cognitive mechanisms of SO-OCD. Specifically, we tested whether the self-help cognitive technique of association splitting (AS) developed from this approach would be efficacious in reducing SO-OCD symptoms and thought suppression. One hundred and twenty heterosexual undergraduates (82 females, 38 males) were randomly assigned to either the AS or waitlist control group. At baseline and four weeks later, participants completed items assessing SO-OCD symptoms, measures of sexual obsessions and thought suppression, and an association task in which they generated associations to different cue words. Generated associations were coded based on SO-OCD relevance and emotional valence. Results indicated reductions in SO-OCD-relevant associations across levels of emotional valence and SO-OCD-irrelevant negative associations, and increases in SO-OCD-irrelevant positive and neutral associations, only in the AS group. Furthermore, there were reductions in SO-OCD symptoms, sexual obsessions, and thought suppression only in the AS group. Importantly, these findings were obtained with overall large effect sizes. AS appears to be an efficacious self-help technique in reducing SO-OCD symptoms, sexual obsessions, and thought suppression. Clinical implications, limitations, and suggestions for future research are discussed.
Cognitive Behaviour Therapy, 47(3) : 229-245
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Fatori, D., deBraganca-Pereira, C. A., Asbahr, F. R., Requena, G., Alvarenga, P. G., deMathis, M. A., Rohde, L. A., Leckman, J. F., March, J. S., Polanczyk, G. V., Miguel, E. C., Shavitt, R. G.
Objective: This sequential multiple assignment randomized trial (SMART) tested the effect of beginning treatment of childhood OCD with fluoxetine (FLX) or group cognitive-behavioral therapy (GCBT) accounting for treatment failures over time. Methods: A two-stage, 28-week SMART was conducted with 83 children and adolescents with OCD. Participants were randomly allocated to GCBT or FLX for 14 weeks. Responders to the initial treatment remained in the same regimen for additional 14 weeks. Non-responders, defined by less than 50% reduction in baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, were re-randomized to either switch to or add the other treatment. Assessments were performed at baseline, 7, 14, 21, and 28 weeks. Results: Among the 43 children randomized to FLX who completed the first stage, 15 (41.7%) responded to treatment and 21 non-responders were randomized to switch to (N = 9) or add GCBT (N = 12). Among the 40 children randomized to GCBT who completed the first stage, 18 (51.4%) responded to treatment and 17 non-responders were randomized to switch to (N = 9) or add FLX (N = 8). Primary analysis showed that significant improvement occurred in children initially treated with either FLX or GCBT. Each time point was statistically significant, showing a linear trend of symptom reduction. Effect sizes were large within (0.76-0.78) and small between (-0.05) groups. Conclusions: Fluoxetine and GCBT are similarly effective initial treatments for childhood OCD considering treatment failures over time. Consequently, provision of treatment for childhood OCD could be tailored according to the availability of local resources. Copyright © 2018 Elsevier Ltd
Journal of Anxiety Disorders, 58 : 42-50
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., Wang, J.
Common mental health problems (CMHPs), such as depression, anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) are internalizing disorders with high comorbidity. University and college students are under many stressors and transitional events, and students fall within the age range when CMHPs are at their developmental peak. Compared to the expanded effort to explore and treat CMHPs, there has been no a meta-analysis that comprehensively reviewed the interventions for CMHPs and examined the effects of interventions for CMHPs in college students. The objective of this review is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining interventions for CMHPs among university and college students and to estimate their post-intervention effect size (ES), as well as follow-up ES, for depression, anxiety disorder, OCD and PTSD separately. Meta-analytic procedures were conducted in accordance with PRISMA guidelines. We reviewed 7768 abstracts from which 331 full-text articles were reviewed and 51 RCTs were included in the analysis. We found moderate effect sizes for both depression (Hedges' g = -0.60) and anxiety disorder (Hedges' g = -0.48). There was no evidence that existing interventions for OCD or PTSD were effective in this population. For interventions with high number of papers, we performed subgroup analysis and found that cognitive behavioral therapy (CBT) and mindfulness-based interventions were effective for both depression and generalized anxiety disorder (GAD), and attention/perception modification was effective for GAD; other interventions (i.e. art, exercise and peer support) had the highest ES for both depression and GAD among university and college students. Copyright © 2018 Elsevier Ltd
Journal of Psychiatric Research, 107 : 1-10
- Year: 2018
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Mindfulness based therapy
Hojgaard, D. R. M. A., Hybel, K. A., Mortensen, E. L., Ivarsson, T., Nissen, J. B., Weidle, B., Melin, K., Torp, N. C., Dahl, K., Valderhaug, R., Skarphedinsson, G., Storch, E. A., Thomsen, P. H.
Our aims were to examine: (1) classes of comorbid disorders in a sample of children and adolescents with Obsessive-Compulsive Disorder (OCD), (2) how these classes relate to obsessive-compulsive symptom dimensions, and (3) the extent to which obsessive-compulsive symptom dimensions predict Cognitive-Behavioral Therapy (CBT) outcome. Participants (N = 269) were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Latent Class Analysis (LCA) was used to identify comorbidity classes. Regression analyses were used to evaluate symptom dimensions as predictors of treatment outcome and their relation to comorbidity classes. Comorbidity was included in the treatment outcome analyses as it can affect outcome. Comorbidity was best categorized by a three-class model and each class was distinctively correlated with the OCD symptom dimensions. Higher scores on the symmetry/hoarding factor increased the chance of responding to CBT by an odds ratio of 1.56 (p = 0.020) when controlled for age, gender, and comorbidity class. The harm/sexual factor (p = 0.675) and contamination/cleaning factor (p = 0.122) did not predict CBT outcome. Three clinically relevant comorbidity subgroups in pediatric OCD were identified. Patients who exhibited higher levels of symmetry/hoarding dimension were more prone to respond to CBT. Copyright © 2018 Elsevier B.V.
Psychiatry Research, 270 : 317-323
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)