Abstract
BackgroundCognitive bias modification (CBM) interventions have demonstrated efficacy in augmenting core biases implicated in psychopathology. The current randomized controlled trial (RCT) will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification intervention for obsessive compulsive disorder (OCD) when compared to a control condition.Methods/DesignPatients meeting diagnostic criteria for a current or lifetime diagnosis of OCD will be recruited via the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (alpha set at 0.05, power at .80) was identified as 29, but increased to 35 to allow for 20% attrition. We will measure the impact of CBM on interpretations bias using the OC Bias Measure (The Ambiguous Scenarios Test for OCD ;AST-OCD) and OC-beliefs (The Obsessive Beliefs Questionnaire-TRIP; OBQ-TRIP). Secondary outcome measures include the Dimensional Obsessive-Compulsive Scale (DOCS), the Patient Health Questionnaire (PHQ-9), The Kessler Psychological Distress Scale (K10), and the Word Sentence Association Test for OCD (WSAO). Change in diagnostic status will be indexed using the OCD Mini International Neuropsychiatric Interview (M.I.N.I) Module at baseline and follow-up. Intent-to-treat (ITT) marginal and mixed-effect models using restricted maximum likelihood (REML) estimation will be used to evaluate the primary hypotheses. Stability of bias change will be assessed at 1-month follow-up.DiscussionA limitation of the online nature of the study is the inability to include a behavioral outcome measure.Trial registrationThe trial was registered on 10 October 2013 with the Australian New Zealand Clinical Trials Registry (ACTRN12613001130752)
Highlights
Cognitive bias modification (CBM) interventions have demonstrated efficacy in augmenting core biases implicated in psychopathology
interpretive bias (CBM-I) procedures may have particular relevance in the context of obsessive compulsive disorder (OCD), given that prominent cognitive models of the disorder assert that intrusive thoughts are experienced by most people, but develop into obsessions when appraised as posing a threat for which the individual is personally responsible
The current randomized controlled trial will provide a test of the utility of a CBM intervention in modifying maladaptive negative interpretation biases associated with OCD
Summary
While CBM-I interventions have been linked to subsequent reductions in anxiety [28] and more adaptive physiological responding during OC stressor tasks [29], change in behavioral responses has not yet been demonstrated. Reviews such as those by Beard [1] and Hallion and Ruscio [2] argue the importance of future studies including both behavioral and neural outcome measures to ascertain the true scope of CBM-I interventions. All authors contributed to refinement of the study protocol and read and approved the final manuscript
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