Disorders - Obsessive Compulsive Disorder
Thompson-Hollands, J., Edson, A., Tompson, M. C., Comer, J. S.
Psychological treatments for obsessive - compulsive disorder (OCD) are increasingly aimed at improving outcomes by directly incorporating family members to address family disruption, dysfunction, or symptom accommodation. Much remains to be learned about the pooled effects of "family inclusive treatment" (FIT) for OCD and factors that may explain variation in response. Random-effects meta-analytic procedures were conducted to empirically evaluate the overall effect of FITs on OCD, and treatment moderators. Study search criteria yielded 29 studies examining FIT response in 1,366 OCD patients. Outcome variables included OCD symptoms and global functioning. Examined moderators included age group, gender, minority status, treatment length and format, and inclusion of specific family focused treatment elements. FITs for OCD demonstrated a large overall effect on OCD symptoms (pooled d = 1.68, SE = 0.14) and global functioning (pooled d = 0.98, SE = 0.14). Moderator analyses found that individual family treatments (vs. group) and FITs targeting family accommodation of symptoms (vs. those that did not target accommodation) were associated with greater improvements in patient functioning. Results indicate a robust overall response to FITs for OCD and clarify key moderators that inform optimal circumstances for effective treatment. Findings underscore the need for continued momentum in the development, evaluation, and dissemination of FITs for OCD. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal of Family Psychology, 28(3) : 287-298
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Other Psychological Interventions
McGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., Storch, E. A.
Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES=1.41, p<0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p=0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p=0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES=0.41, p=0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.
Journal of Psychiatric Research, 58 : 76-83
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Freeman, J., Garcia, A., Frank, H., Benito, K., Conelea, C., Walther, M., Edmunds, J.
Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings. Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, this issue). Findings from this review clearly converge in support of cognitive-behavioral therapy as an effective and appropriate first line treatment for youth with OCD (either alone or in combination with medication). Although no treatment for pediatric OCD has yet to be designated as "well-established," both individual and individual family-based treatments have been shown to be "probably efficacious." Moderators and predictors of treatment outcome are discussed as are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a review of the evidence base are reviewed. Finally, future research directions are outlined. (copyright) 2014 Copyright Taylor and Francis Group, LLC.
Journal of Clinical Child & Adolescent Psychology, 43(1) : 7-26
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Sanchez-Meca, J., Rosa-Alcazar, A. I., Iniesta-Sepulveda, M., Rosa-Alcazar, A.
The aim of this paper is to present a meta-analysis about the differential efficacy of cognitive-behavioral therapy (CBT), pharmacological and combined treatment for pediatric obsessive-compulsive disorder (OCD). The literature research and the application of the inclusion criteria enabled us to locate 18 studies, yielding a total of 24 independent comparisons between a treated (10 pharmacological, 11 CBT, and 3 combined interventions) and a control group. All types of interventions were efficacious in reducing obsessive-compulsive symptoms, with effect sizes adjusted by the type of control group of d=1.203 for CBT, d=0.745 for pharmacological treatments, and d=1.704 for mixed treatments. Depression, anxiety and other secondary responses were also improved, especially with CBT interventions. The analysis of moderator variables showed that the CBT protocol and the total of intervention hours exhibited a significant influence on the effect size. Within pharmacological treatment, clomipramine (d=1.305) was more efficacious than selective serotonin reuptake inhibitors (d=0.644), but its adverse effects were more severe. Finally, the clinical implications of the results are discussed.; Copyright © 2013 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 28(1) : 31-44
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Shavitt, R. G., DeMarco, M., Batistuzzo, M. C., Oki, F. H., Bernardes, E., Monti, C., Morais, I., Borcato, S. R., Fatori, D.
Background: Neuropsychological studies indicate that impairment on planning strategies could mediate visual episodic memory deficits observed in obsessivecompulsive disorder (OCD) patients. The aims of this study were: (1) to verify if episodic memory is affected by visual information planning strategies and (2) to explore the influence of treatment on the improvement of planning and nonverbal memory skills in pediatric patients. Methods: Sixty-five OCD patients, aged 6-17 years, participating in a randomized trial, were evaluated at baseline and post-treatment with either group Cognitive- Behavioral Therapy (CBT, n=33) or Fluoxetine (FLX, n=32). CBT was delivered in 2-hour sessions for 14 weeks. FLX was administered in a daily dose range of 20-60mg for 14 weeks. Severity of symptoms was measured with the Yale-Brown Obsessive-Compulsive Scale at baseline and post-treatment. Planning skills and nonverbal memory were assessed through the Rey Complex Figure (at baseline) and the Taylor Complex Figure (at post-treatment). Results: At baseline, a linear regression analysis indicated that planning strategies affected performance in recall information (immediate recall: r2=0.20, (beta)=2.28, p<0.001; delayed recall: r2=0.16, (beta)=2.15, p=0.001). At post-treatment, the Wilcoxon test showed a significant improvement on the planning ability (p<0.001), on the immediate (p<0.001) and delayed recall (p<0.001) of the complex figure. Moreover, both treatments were equally effective in improving the cognitive performance in the aforementioned tests (Mann-Whitney test, p<0.001). Conclusions: First line treatments for OCD, regardless the modality (cognitivebehavioral therapy or pharmacological), seem to positively influence the planning ability and nonverbal memory in OCD pediatric patients.
Biological Psychiatry, 75(9) : 195S
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Grant, Paul. J., Joseph, Lisa. A., Farmer, Cristan. A., Luckenbaugh, David. A., Lougee, Lorraine. C., Zarate, Carlos. A., Jr., Swedo, Susan. E.
Many children with childhood-onset obsessive-compulsive disorder (OCD) fail to respond adequately to standard therapies. Evidence from preclinical and clinical studies suggests that the glutamatergic neurotransmitter system might be an alternative treatment target. This study examined the efficacy of riluzole, a glutamatergic modulator, as an adjunctive therapy for children with treatment-resistant OCD. In a 12-week, double-blind, placebo-controlled study, 60 treatment-resistant children and adolescents (mean age= 14.5 ± 2.4 years), with moderate to severe OCD (mean Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) = 28.2 ± 3.7), 17 of whom also had concomitant autism spectrum disorder, were randomized to receive riluzole (final dose of lOOmg/day) or placebo in addition to the existing treatment regimen. Fifty-nine subjects completed the randomized trial. Primary outcome measures were changes on the CY-BOCS, the Clinical Global Impressions Scale, and the Children's Global Assessment Scale. Riluzole was fairly well tolerated, although it was associated with one case of pancreatitis and five instances of slight increases in transaminases. All subjects showed significant reductions in CY-BOCS scores during treatment; however, there was no significant difference between placebo and riluzole on any of the primary or secondary outcome measures. The study failed to demonstrate superiority of riluzole over placebo as an adjunctive treatment for children with childhood-onset OCD. However, future studies may show benefits for less treatment-refractory children with fewer concomitant medications. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Neuropsychopharmacology, 39(6) : 1453-1459
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Grisham, J. R., Becker, L., Williams, A. D., Whitton, A. E., Makkar, S. R.
Cognitive-behavioural models of compulsive checking posit a dominant role for beliefs regarding onenulls responsibility to prevent harm. In the current study we employed a computerised cognitive bias modification of interpretation (CBM-I) paradigm to target and modify responsibility biases in a sample of undergraduate students with high levels of checking symptoms (N = 100). Participants were randomly assigned to either a positive (decrease responsibility bias) or negative (increase responsibility bias) CBM-I training condition. Relative to participants in the negative training condition, participants in the positive training condition demonstrated reduced responsibility bias in a subsequent interpretive bias test. Positive training also resulted in more adaptive physiological responding during a responsibility stressor task. There were no differential effects of CBM-I training, however, on observed or self-reported checking or self-reported responsibility beliefs. In light of these mixed findings, we outline future avenues for improving the efficacy of CBM-I training targeting responsibility biases.
Cognitive Therapy & Research, 38(5) : 505-517
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Mataix-Cols, D., Turner, C., Monzani, B., Isomura, K., Murphy, C., Krebs, G., Heyman, I.
A partial N-methyl-D-aspartate agonist, D-cycloserine, enhances fear extinction when given before or shortly after exposure to feared stimuli in animals. In this pilot double-blind placebo-controlled trial (trial number: ISRCTN70977225), 27 youth with obsessive-compulsive disorder were randomised to either 50mg D-cycloserine or placebo administered immediately after each of ten cognitive-behavioural therapy (CBT) sessions, primarily consisting of exposure and ritual prevention. Both groups improved significantly and maintained their gains at 1-year follow-up, with no significant advantage of D-cycloserine over placebo at any time point. The effects of CBT may not be augmented or accelerated when D-cycloserine is administered after sessions.
British Journal of Psychiatry, 204(1) : 77-78
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, D-cycloserine (DCS)
Freeman, J., Sapyta, J., Garcia, A., Compton, S., Khanna, M., Flessner, C., FitzGerald, D., Mauro, C., Dingfelder, R., Benito, K., Harrison, J., Curry, J., Foa, E., March, J., Moore, P., Franklin, M.
IMPORTANCE Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD) among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. OBJECTIVE To examine the relative efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention vs an FB relaxation treatment (FB-RT) control condition for children 5 to 8 years of age. DESIGN, SETTING, AND PARTICIPANTS A 14-week randomized clinical trial (Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children [POTS Jr]) conducted at 3 academic medical centers between 2006 and 2011, involving 127 pediatric outpatients 5 to 8 years of age who received a primary diagnosis of OCD and a Children's Yale-Brown Obsessive Compulsive Scale total score of 16 or higher. INTERVENTIONS Participants were randomly assigned to 14 weeks of (1) FB-CBT, including exposure plus response prevention, or (2) FB-RT. MAIN OUTCOMES AND MEASURES Responder status defined as an independent evaluator-rated Clinical Global Impression-Improvement scale score of 1 (very much improved) or 2 (much improved) and change in independent evaluator-rated continuous Children's Yale-Brown Obsessive Compulsive Scale total score. RESULTS Family-based CBT was superior to FB-RT on both primary outcome measures. The percentages of children who were rated as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale at 14 weeks were 72%for FB-CBT and 41% for FB-RT. The effect size difference between FB-CBT and FB-RT on the Clinical Global Impression-Improvement scale was 0.31 (95%CI, 0.17-0.45). The number needed to treat (NNT) with FB-CBT vs FB-RT was estimated as 3.2 (95%CI, 2.2-5.8). The effect size difference between FB-CBT and FB-RT on the Children's Yale-Brown Obsessive Compulsive Scale at week 14 was 0.84 (95%CI, 0.62-1.06). CONCLUSIONS AND RELEVANCE A comprehensive FB-CBT program was superior to a relaxation program with a similar format in reducing OCD symptoms and functional impairment in young children (5-8 years of age) with OCD. Copyright 2014 American Medical Association. All rights reserved.
JAMA Psychiatry, 71(6) : 689-698
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention, Relaxation
Park, J. M., Small, B. J., Geller, D. A., Murphy, T. K., Lewin, A. B., Storch, E. A.
Clinical studies in adults and children with obsessive - compulsive disorder (OCD) have shown that D-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive- behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal of Child & Family Studies, 23(5) : 863-871
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention, D-cycloserine (DCS)
Baldwin, D.S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den-Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O'Neill, C, Scott, J., van-der-Wee, N., Wittchen, H-U.,
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.;
Journal of Psychopharmacology, 28(5) : 403-439
- Year: 2014
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Beadel, J. R., Smyth, F. L., Teachman, B. A.
Multiple studies have found that cognitive bias modification (CBM) can be an effective intervention to reduce maladaptive, anxiety-linked cognitive biases and symptoms, but little is known about how it achieves its effects. CBM is posited to work by altering contingency learning about potential threat cues, rather than via habituation of fear and arousal (as hypothesized for exposure-based interventions). In the current study, multi-level modeling was used to examine the trajectories of potential change processes over the course of CBM for interpretation bias in a sample high in obsessive-compulsive (OC) symptoms (n = 75). Psychophysiological arousal (heart rate and galvanic skin response), subjective fear, and the development of a learned contingency between ambiguity tied to threat and safe outcomes were measured before, during, and after CBM. Results showed that, compared to a control group, CBM was effective at reducing OC beliefs (though not responses to subsequent OC stressors). Additionally, as expected, only contingency learning significantly changed as a function of training condition, while subjective fear and arousal did not. Moreover, post-training indicators of contingency learning predicted the extent OC beliefs changed from pre- to post-training for the "positive" CBM group only (and not for the control group). This indicates that CBM is likely not operating similarly to habituation, but is instead marked by change in cognitive processing. However, change in contingency learning did not fully mediate the effect of this intervention on change in OC beliefs, suggesting more work is needed to fully understand the mechanisms underlying CBM. (copyright) 2013 Springer Science+Business Media.
Cognitive Therapy & Research, 38(2) : 103-119
- Year: 2014
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification