Disorders - Obsessive Compulsive Disorder
Fabricant, L. E., Abramowitz, J. S., Dehlin, J. P., Twohig, M. P.
Exposure and response prevention (ERP) is the most effective psychological treatment for unwanted, intrusive thoughts associated with obsessive-compulsive disorder (OCD). However, the procedures involved in ERP (i.e., exposure) are challenging, provoke high levels of anxiety, and may contribute to treatment refusal and dropout (Franklin & Foa, 1998). To address this problem, researchers have begun to evaluate alternative treatments for OCD, such as Acceptance and Commitment Therapy (ACT). Despite the value of both techniques, little is known about the differential impact of these strategies. This study examined the relative effects of a single session of ACT or exposure for obsessional thoughts. There were 56 undergraduate participants with obsessional thoughts randomly assigned to receive a brief intervention with the core components of exposure, ACT, or an expressive writing control condition. Obsessional symptoms and related process variables were assessed at baseline and at 1-week follow-up. There were no statistical differences in believability or acceptability of the 3 conditions. Significant reductions in obsessional severity, behavioral tests of distress and willingness to experience intrusive thoughts, and negative appraisals of intrusive thoughts occurred in all conditions, but no differences were found between these conditions. Furthermore, changes in dysfunctional beliefs, but not in willingness to experience intrusive thoughts, predicted changes in obsessional symptoms in both the ACT and exposure conditions. (copyright) 2013 Springer Publishing Company.
Journal of Cognitive Psychotherapy, 27(3) : 195-209
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Acceptance & commitment therapy (ACT)
, Creative expression: music, dance, drama, art
Farrell, Lara J., Waters, Allison M., Boschen, Mark J., Hattingh, Laetitia, McConnell, Harry, Milliner, Ella L., Collings, Nigel, Shelton, Doug, Ollendick, Thomas H., Testa, Chris, Storch, Eric A.
Background: This study examined the feasibility and preliminary effectiveness of D-cycloserine (DCS) - augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult-to-treat Obsessive Compulsive Disorder, in a double-blind randomized controlled pilot trial (RCT). Methods: Seventeen children and adolescents (aged 8 - 18 years) with a primary diagnosis of OCD, which was deemed difficult-to-treat, were randomly assigned to either nine sessions of CBT including five sessions of DCS-augmented exposure and response prevention (ERP) [ERP + DCS] or nine sessions of CBT including five sessions of placebo-augmented ERP [ERP + PBO]. Weight-dependent DCS or placebo doses (25 or 50 mg) were taken 1 hour before ERP sessions. Results: At posttreatment, both groups showed significant improvements with 94% of the entire sample classified as responders. However, a greater improvement in the ERP + DCS relative to the ERP + PBO condition was observed at 1-month follow-up on clinician-rated obsessional severity and diagnostic severity, and parent ratings of OCD severity. There were no changes across time or condition from 1- to 3-month follow-up. Conclusions: In this preliminary study, DCS-augmented ERP produced significant improvements in OCD severity from posttreatment to 1-month follow-up, relative to a placebo control condition, in severe and difficult-to-treat pediatric OCD. The significant effect on obsessional severity suggests that DCS augmentation might be associated with enhanced modification of obsessional thoughts during ERP, and warrants further investigation. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Depression & Anxiety, 30(8) : 723-731
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
, Treatment resistant/treatment refractory
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention, D-cycloserine (DCS)
Fineberg, Naomi A., Reghunandanan, Samar, Brown, Angus, Pampaloni, Ilenia
Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder associated with a significant degree of functional disability and poor quality of life. Pharmacotherapy may have a substantial impact on the course and outcome of OCD.; Method: We review the evidence supporting available strategies for the pharmacological treatment of OCD.; Results: Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice and are associated with improved health-related quality of life. Discontinuation is associated with relapse and loss of quality of life, implying treatment should continue long-term. A substantial minority of patients who fail to respond to SSRI may benefit from dose elevation or adjunctive antipsychotics, though long-term trials validating the effectiveness and tolerability of these strategies are relatively lacking.; Conclusion: The pharmacological evidence-base for the treatment of OCD is becoming increasingly robust. Treatment with SSRIs and clomipramine remains uncontroversial and improvements are sustained over time. Newer compounds targeting serotonin receptor subtypes and other neurotransmitter systems are undergoing evaluation.;
Australian & New Zealand Journal of Psychiatry, 47(2) : 121-141
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
Peris, Tara S., Piacentini, John
Family factors such as conflict, blame, and poor cohesion have been found to attenuate response to cognitive behavior therapy (CBT) for pediatric obsessive compulsive disorder (OCD). This study examined the feasibility and acceptability of a brief, personalized intervention for cases of pediatric OCD complicated by these family features. Twenty youth with a primary Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of OCD (M age = 12.50 years; 55% male; 60% Caucasian) and their families participated. To be included in the study, families were required to evidence poor functioning on measures of blame, conflict, and/or cohesion. Eligible families were randomly assigned either to standard treatment (ST) with 12 weeks of individual child CBT that included weekly parent check-ins and psychoeducation or to Positive Family Interaction Therapy (PFIT), which consisted of 12 weeks of individual child CBT plus an additional 6 sessions of family treatment aimed at shifting family dynamics. Clinical outcomes were determined by blind independent evaluators using the Clinician's Global Impressions-Improvement (CGI-I) scale. All families completed the study. High levels of satisfaction were reported among participants in both arms of the study, despite the added burden of attending the PFIT sessions. Both mothers and fathers attended 95% of the PFIT family sessions. Families in the ST condition demonstrated a 40% response rate on the CGI-I; families in the PFIT condition demonstrated a 70% response rate. Treatment gains were maintained in both conditions at 3-month follow-up. Preliminary data suggest that PFIT is acceptable and feasible. Further testing and treatment development are needed to optimize outcomes for complicated cases of pediatric OCD.;
Journal of Clinical Child & Adolescent Psychology, 42(1) : 1-8
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy
Koprivova, J., Congedo, M., Raszka, M., Prasko, J., Brunovsky, M., Horacek, J.
Aims: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. Methods: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. Results: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. Conclusion: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance. (copyright) 2013 S. Karger AG, Basel.
Neuropsychobiology, 67(4) : 210-223
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Biofeedback, neurofeedback, audio/video feedback
Reynolds, S. A., Clark, S., Smith, H., Langdon, P. E., Payne, R., Bowers, G., Norton, E., McIlwham, H.
Objective: Obsessive-compulsive disorder (OCD) in young people can be effectively treated with Cognitive Behavior Therapy (CBT). Practice guidelines in the United Kingdom recommend that CBT be delivered with parental or family involvement; however, there is no evidence from randomized trials that this enhances effectiveness. The aim of this trial was to assess if CBT with high parental involvement was more effective than CBT with low parental involvement (individual CBT) in reducing symptoms of OCD. Method: Fifty young people ages 12-17 years with OCD were randomly allocated to individual CBT or parent-enhanced CBT. In parent-enhanced CBT parents attended all treatment sessions; in individual CBT, parents attended only Sessions 1, 7, and the final session. Participants received up to 14 sessions of CBT. Data were analyzed using intent-to-treat and per-protocol methods. The primary outcome measure was the Children's Yale-Brown Obsessive Compulsion Scale (Scahill et al., 1997). Results: Both forms of CBT significantly reduced symptoms of OCD and anxiety. Change in OCD symptoms was maintained at 6 months. Per-protocol analysis suggested that parent-enhanced CBT may be associated with significantly larger reductions in anxiety symptoms. Conclusions: High and low parental involvement in CBT for OCD in young people were both effective, and there was no evidence that 1 method of delivery was superior on the primary outcome measure. However, this study was small. Future trials should be adequately powered and examine interactions with the age of the young person and comorbid anxiety disorders. (copyright) 2013 American Psychological Association.
Journal of Consulting & Clinical Psychology, 81(6) : 1021-1026
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Rezvan, S., Bahrami, F., Abedi, M., Macleod, C., Doost, H. T. N., Ghasemi, V.
Background: Research on attachment has shed new light on understanding one of the underlying mechanisms of psychopathology in children. The aim of this study was to investigate the therapeutic efficacy of attachment based intervention in a pediatric sample with obsessive compulsive disorder (OCD). Methods: Twelve participants, 10-12 years of age, were treated across an eight week period. They had not been treated with either pharmacotherapy or psychotherapy previously and remained medication free during the attachment based therapy. This study comprised two groups of children: The experimental group, who received attachment based intervention, and the control group, who did not receive treatment. All participants were assessed in terms of severity of OCD symptoms by administrating the Children's Yale-Brown Obsessive-Compulsive Scale before and after the experimental group had received the therapeutic sessions. The children were assessed again one month later. The level of children's depression, and attachment insecurity, as well as their mothers' depression, OCD symptoms, and attachment insecurity, were statistically controlled in this study. Results: Multivariate analysis of covariance (MANCOVA) indicated that the OCD symptoms in children decreased significantly over the course of the therapy, and this gain was maintained at follow up. The results of this study demonstrated that the attachment based intervention was efficacious in alleviating the OCD symptoms. Conclusion: It is suggested that parental instruction in attachment based relationships may help prevent young children from developing OCD symptoms in middle childhood and adulthood.
International Journal of Preventive Medicine, 4(1) : 78-87
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Olatunji, Bunmi O., Davis, Michelle L, Powers, Mark B., Smits, Jasper A. J.
The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) as well as potential moderators that may be associated with outcome. A literature search revealed sixteen randomized-controlled trials (RCTs) with a total sample size of 756 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 1.39) and at follow-up (Hedges's g = 0.43). Subsequent analyses revealed few moderators of CBT efficacy. Neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size. Similarly, effect size did not vary as a function of 'type' of CBT, treatment format, treatment integrity assessment, blind assessment, age of onset, duration of symptoms, percentage of females, number of sessions, or percent comorbidity. However, active treatments showed smaller effect sizes when compared to placebo controls than when compared to waitlist controls. Effect sizes were also smaller for adult RCTs than child RCTs. Likewise, older age was associated with smaller effect sizes. However, an association between age and effect size was not observed when examining child and adult samples separately. This review indicates that while CBT is efficacious in the treatment of OCD, more research is needed to identify processes that may predict more favorable treatment responses.; Copyright © 2012 Elsevier Ltd. All rights reserved.
Journal of Psychiatric Research, 47(1) : 33-41
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Storch, Eric A., Bussing, Regina, Small, Brent J., Geffken, Gary R., McNamara, Joseph P., Rahman, Omar, Lewin, Adam B., Garvan, Cynthia S., Goodman, Wayne K., Murphy, Tanya K.
Background: To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive−compulsive disorder (OCD). Methods: Forty-seven children and adolescents with OCD (Range = 7−17 years) were randomized to 18- weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline,weeks 1−9,13, and 17, and post-treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive−Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale−Parent/Child, Children's Depression Rating Scale-Revised,Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity. Results: All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable. Conclusions: Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Behaviour Research & Therapy, 51(12) : 823-829
- Year: 2013
- 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)
Rosa-Alcazar, A. I., Iniesta-Sepulveda, M., Rosa-Alcazar, A.
We present the results of a systematic review on the effectiveness of pharmacological treatments for children and adolescents with obsessive-compulsive disorder. Sixty-four studies fulfilled the selection criteria, being the most of them focused in SSRI and Clomipramine. The trials on augmentation strategies and third line monotherapies are scarce, being the majority open-trials and case series. Similarly, studies on combined treatment (psychological and pharmacological) are few; furthermore this is a relevant future research line. It is also remarkable the lack of quasi-experimental and experimental comparison studies and the long-term follow-up measures.
Actas Espanolas De Psiquiatria, 41(3) : 196-203
- Year: 2013
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants (any)
Herbst, Nirmal, Voderholzer, Ulrich, Stelzer, Nicola, Knaevelsrud, Christine, Hertenstein, Elisabeth, Schlegl, Sandra, Nissen, Christoph Kulz, Anne Katrin
Background: Only a small percentage of patients with obsessive-compulsive disorder (OCD) receive adequate treatment. Reasons include a high level of shame and stigmatisation and the paucity of specialised treatment services. Telemental health (TMH) treatment could improve the therapeutic situation as has been shown for various mental disorders. This review critically evaluates the current body of evidence on TMH applications for OCD patients. The review focuses on studies that include exposure therapy with response prevention as the best validated treatment component.; Methods: Relevant publications were identified through computerised searches of the databases PsycINFO and PubMed and manual searches. No date or study type restrictions were applied.; Results: Twenty-four studies on different types of TMH applications were identified: bibliotherapy (7), telephone-delivered (11), computer-aided (3), online self-help group (1) and video-conference (2). Nearly all interventions lead to a significant improvement of OC symptoms. Effect sizes ranged from 0.46 to 2.5.; Conclusions: Preliminary evidence suggests that TMH applications represent a low-threshold, efficacious, time-effective and economic treatment for patients with OCD. Future studies are needed to further investigate the potential of TMH treatment to improve health care for patients with OCD.; Copyright © 2012 Elsevier Ltd. All rights reserved.
Clinical Psychology Review, 32(6) : 454-466
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Geller, DA, March, MD
Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral therapy, pharmacotherapy, combined treatment, and other interventions. (copyright) 2012 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 51(1) : 98-113
- Year: 2012
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)