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.
Highlights
Obsessive–compulsive disorder (OCD) is a debilitating mental health condition characterized by obsessions and compulsions, which affects 2–3% of the population (Brakoulias et al, 2017)
percentage of all non-overlapping data (PAND), non-overlap of all pairs (NAP), and points exceeding the median (PEM) were all equal to 100% for the obsessive dimension and the overall score of Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), whereas around 93% for the compulsions dimension
A similar trend is found when we look at the Yale–Brown’s sub-dimensions: all participants reported a reliable improvement on the compulsions dimension of the Y-BOCS after the treatment
Summary
Obsessive–compulsive disorder (OCD) is a debilitating mental health condition characterized by obsessions (persistent and distressing thoughts, images, doubts, or urges) and compulsions (interfering and ritualistic mental or physical behaviors the individual feels compelled to perform in order to alleviate distress and/or prevent negative outcomes; American Psychiatric Association APA, 2013), which affects 2–3% of the population (Brakoulias et al, 2017). Effective treatments for OCD exist, such as cognitive–behavior therapy (CBT) that includes exposure and response prevention (ERP), only about half of patients seem to benefit from them when treatment refusal and dropout rates are taken into account (e.g., Fisher and Wells, 2005). This constitutes a limit of the actual treatments of OCD, given that patients who attain only partial recovery are less likely to maintain their treatment improvements (Simpson et al, 2004), and their quality of life is negatively impacted by residual symptoms (Fontenelle et al, 2010; Key et al, 2017). Retrospective accounts of childhood experiences of guilt induction significantly predicted feelings of mental contamination and washing rituals in non-clinical individuals (Berman et al, 2012)
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