CBT For Obsessive-compulsive Disorder Research Articles

Extended formulation in cognitive behavioural therapy for OCD: a single case experimental design

Abstract The demanding nature of exposure work that forms an essential component of exposure and response prevention (ERP) for obsessive compulsive disorder (OCD) is for some patients intolerable and leads to disengagement. The addition of cognitive therapy to ERP (CBT) with a focus on developing a shared understanding of how OCD works may aid engagement. This paper reports a case study of an individual who had not responded to two previous courses of ERP due to engagement difficulties with the treatment rationale. This study aimed to establish if CBT for OCD, incorporating an extended period of assessment and longitudinal formulation, would: (1) aid in engagement with the treatment rationale and therapy and (2) lead to an improvement in OCD symptoms, general functioning and mood. An A–B single case experimental design was used. Standardised measures were collected at weekly intervals over 15 sessions of CBT, in conjunction with pre–post idiographic behavioural measures. The extended formulation was successful in helping the individual to develop a less threatening understanding of how OCD works, enabling her to engage in therapy. This led to a reduction in the duration of the overt compulsions in her behavioural measures although on the standardised measures there was no change in self-reported OCD symptoms. The patient’s covert rituals and underlying responsibility and control beliefs largely remained intact, thus maintaining her OCD and requiring further intervention. There was a significant improvement in social functioning and consequently the patient reported being able to regain a sense of some control in her life. Key learning aims (1) To describe the factors that might lead to a patient disengaging from exposure work in treatment for OCD. (2) To identify the advantages and disadvantages of incorporating a period of extended formulation when working with patients who have not previously been able to tolerate exposure work. (3) To describe ways of monitoring observable improvements in areas of functioning that matter to the patient in order to help them to celebrate their progress and boost their sense of self-efficacy.

Waitlist-Control Trial of Smartphone CBT for Obsessive-Compulsive Disorder (OCD)

Waitlist-Control Trial of Smartphone CBT for Obsessive-Compulsive Disorder (OCD)

Cost-effectiveness analysis of telephone cognitive-behaviour therapy for adolescents with obsessive-compulsive disorder.

Telephone cognitive-behaviour therapy (TCBT) may be a cost-effective method for improving access to evidence-based treatment for obsessive-compulsive disorder (OCD) in young people.AimsEconomic evaluation of TCBT compared with face-to-face CBT for OCD in young people. Randomised non-inferiority trial comparing TCBT with face-to-face CBT for 72 young people (aged 11 to 18) with a diagnosis of OCD. Cost-effectiveness at 12-month follow-up was explored in terms of the primary clinical outcome (Children's Yale-Brown Obsessive-Compulsive Scale, CY-BOCS) and quality-adjusted life-years (QALYs) (trial registration: ISRCTN27070832). Total health and social care costs were higher for face-to-face CBT (mean total cost £2965, s.d.=£1548) than TCBT (mean total cost £2475, s.d.=£1024) but this difference was non-significant (P=0.118). There were no significant between-group differences in QALYs or the CY-BOCS and there was strong evidence to support the clinical non-inferiority of TCBT. Cost-effectiveness analysis suggests a 74% probability that face-to-face CBT is cost-effective compared with TCBT in terms of QALYs, but the result was less clear in terms of CY-BOCS, with TCBT being the preferred option at low levels of willingness to pay and the probability of either intervention being cost-effective at higher levels of willingness to pay being around 50%. Although cost-effectiveness of TCBT was sensitive to the outcome measure used, TCBT should be considered a clinically non-inferior alternative when access to standard clinic-based CBT is limited, or when patient preference is expressed.Declaration of interestD.M.-C. reports research grants from the Swedish Research Council (Vetenskapsrådet), the Swedish Research Council for Health, working life and welfare (Forte), the US National Institute of Mental Health (NIMH), the UK National Institute of Health Research (NIHR), as well as royalties from Wolters Kluwer Health and Elsevier, all unrelated to the submitted work.

What matters more? Common or specific factors in cognitive behavioral therapy for OCD: Therapeutic alliance and expectations as predictors of treatment outcome

CBT for obsessive-compulsive disorder (OCD) is a strong challenge to the contention that common factors explain most of the variance in outcomes in all therapies and all disorders, given that the treatment is focused and placebo response is low. In this study, the relative contributions of expectancy and therapeutic alliance as predictors of outcome in the treatment of OCD are examined and compared to the contribution of specific treatment effects. One hundred and eight patients with OCD were randomly assigned to two forms of CBT: exposure and response prevention (EX/RP) or stress management training (SMT). Measures of OCD symptoms, quality of life, therapist and patient expectancy and alliance were collected at several timepoints. Treatment type was a substantially stronger predictor of symptom reduction compared to alliance and expectancy. However, neither specific nor common factors predicted improvement in quality of life very well. Only in EX/RP, symptom change was associated with subsequent changes in alliance. Finally, therapist effects were estimated using Bayesian methods and were negligible. In the context of CBT for OCD, the data support the specific factor model, and suggest that the relative contribution of common vs. specific factors likely varies by disorder and by treatment type.

Working with interpretations in cognitive behavioural therapy for obsessive compulsive disorder

AbstractCognitive behavioural therapy (CBT) is a highly effective treatment for obsessive compulsive disorder (OCD). Identifying, challenging and monitoring interpretations of intrusions is considered a key element of CBT for OCD but preliminary research suggests that treatment does not always include identification and modification of misinterpretations. The present investigation explored ‘OCD-expert’ and ‘non-OCD-expert’ clinicians’ views on key elements of CBT for OCD to determine whether identifying and modifying key interpretations were considered important in therapy and whether clinicians who do not have specific expertise in OCD found working with interpretations difficult. Study 1 used a qualitative approach to investigate OCD-expert and non-OCD-expert clinician's views on key elements of CBT for OCD. Study 2 used a questionnaire to investigate what non-OCD-expert clinicians viewed as important and difficult aspects of CBT for OCD. Study 1 results showed that OCD-expert and non-OCD-expert clinicians reported working with interpretations was a key element of CBT for OCD. However, OCD-expert clinicians linked interpretations more closely to a formulation and intervention plan and reported using more techniques and questionnaires when working with interpretations compared with non-OCD-expert clinicians. Study 2 results showed that non-OCD-expert clinicians rated interpretations as both important and difficult to work with but no more important or difficult than other key elements of CBT for OCD. OCD-expert and non-OCD-expert clinicians identify working with interpretations as a key element of CBT for OCD. Non-OCD-expert clinicians may benefit from additional training on formulation tools that help identify, monitor and challenge interpretations of intrusions.

The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder

The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment.

CBT for OCD: The rationale, protocol, and challenges

Behavior therapy, specifically exposure plus response prevention (ERP) has been firmly established as the treatment of choice for obsessive-compulsive disorder (OCD). However, the dropout rates plus the percentage of people who do not benefit from ERP require reconsideration. For those people who do receive benefit, a considerable portion of the presenting OC symptoms remain, often necessitating further treatment. Newer cognitive-behavioral approaches that focus on challenging OCD appraisals and beliefs have been proposed as alternatives to ERP. The CBT conceptualization, rationale, and treatment strategies are described, as are the challenges. The pros and cons of conducting treatment in groups are also discussed.