Cognitive-behavioral Therapy For Obsessive-compulsive Disorder Research Articles

Metacognitive Therapy Versus Cognitive Behavioral Therapy for OCD: A Randomized Controlled Trial

Background and Objectives: Obsessive-compulsive disorder (OCD) is a disabling condition with a lifetime prevalence of approximately 2 - 3% in the general population. This paper presents the first controlled study that examines the effects of CBT compared with MCT in the treatment of OCD. Methods: This paper presents an experimental study carried out individually with group-level comparison. Using a parallel design, participants were randomly assigned to either CBT or MCT. The study was conducted in the psychiatric clinic of Imam Hossein Hospital in Tehran, Iran. Of the 47 participants who were assessed, 27 started treatment (CBT = 13, MCT = 14), and 24 were available for a three-month follow-up. Participants were randomly assigned to either 10 weeks of CBT or MCT. Results: Clinically significant changes on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) using Jacobson methodology/Asymptomatic criteria as the index of outcome were 16.7%/0% and 66.7%/41.7% in CBT and MCT, respectively. With respect to Y-BOCS, the effect sizes of MCT (3.28) at post-test and one-month follow-up were higher than that of CBT (1.66). Although both interventions were efficacious in reducing disorder severity, improving QoL, and functioning at post-test, MCT was statistically and clinically more significant. Both interventions led to equally high reductions in depression and anxiety that were apparent in the two follow-ups. Symptom reduction on the Y-BOCS was stable or slightly improving in MCT; however, recovery rates in CBT declined. Conclusions: It is possible that change in MCT occurs through more direct alteration in the brain’s executive function (EF) and modification of EF inputs, addressing a major problem of OCD. Further replication is required as MCT offers a promising alternative treatment approach.

Predictors of outcome in self-guided internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder: A preliminary investigation.

Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (Mage = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F(8, 148) = 15.844, p < .001) and completer sample (F(8, 101) = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.

Differential effects of sertraline and cognitive behavioural therapy on behavioural inhibition in patients with obsessive compulsive disorder.

Patients with obsessive compulsive disorder (OCD) randomised to sertraline, manualised cognitive behavioural therapy (CBT), or combination (sertraline + CBT), underwent cognitive assessment. Cognitive testing was conducted at baseline and at week 16. The stop signal reaction time task (SSRT) was used to evaluate motor impulsivity and attentional flexibility was evaluated using the intra/extra-dimensional set shifting task. Paired-samples t -tests or nonparametric variants were used to compare baseline and posttreatment scores within each treatment group. Forty-five patients were tested at baseline (sertraline n = 14; CBT n = 14; sertraline + CBT n = 17) and 23 patients at week 16 (sertraline n = 6; CBT n = 7; sertraline + CBT n = 10). The mean dosage of sertraline was numerically higher in those taking sertraline as a monotherapy (166.67 mg) compared with those taking sertraline in combination with CBT (100 mg). Analysis of pre-post treatment scores using an intent-to-treat-analysis found a significant reduction in the SSRT in those treated with sertraline, whilst there was no significant change on this task for those treated with CBT or the combination. This study found that motor inhibition improved significantly following sertraline monotherapy. Suboptimal sertraline dosing might explain the failure to detect an effect on motor inhibition in the group receiving combination of sertraline + CBT. Higher dose sertraline may have broader cognitive effects than CBT for OCD, motor impulsivity may have value as a measure of treatment outcome and, by extension, the SSRT could serve as a biomarker for personalising care.

A Wearable Artificial Intelligence Feedback Tool (Wrist Angel) for Treatment and Research of Obsessive Compulsive Disorder: Protocol for a Nonrandomized Pilot Study.

Obsessive compulsive disorder (OCD) in youth is characterized by behaviors, emotions, physiological reactions, and family interaction patterns. An essential component of therapy involves increasing awareness of the links among thoughts, emotions, behaviors, bodily sensations, and family interactions. An automatic assessment tool using physiological signals from a wearable biosensor may enable continuous symptom monitoring inside and outside of the clinic and support cognitive behavioral therapy for OCD. The primary aim of this study is to evaluate the feasibility and acceptability of using a wearable biosensor to monitor OCD symptoms. The secondary aim is to explore the feasibility of developing clinical and research tools that can detect and predict OCD-relevant internal states and interpersonal processes with the use of speech and behavioral signals. Eligibility criteria for the study include children and adolescents between 8 and 17 years of age diagnosed with OCD, controls with no psychiatric diagnoses, and one parent of the participating youths. Youths and parents wear biosensors on their wrists that measure pulse, electrodermal activity, skin temperature, and acceleration. Patients and their parents mark OCD episodes, while control youths and their parents mark youth fear episodes. Continuous, in-the-wild data collection will last for 8 weeks. Controlled experiments designed to link physiological, speech, behavioral, and biochemical signals to mental states are performed at baseline and after 8 weeks. Interpersonal interactions in the experiments are filmed and coded for behavior. The films are also processed with computer vision and for speech signals. Participants complete clinical interviews and questionnaires at baseline, and at weeks 4, 7, and 8. Feasibility criteria were set for recruitment, retention, biosensor functionality and acceptability, adherence to wearing the biosensor, and safety related to the biosensor. As a first step in learning the associations between signals and OCD-related parameters, we will use paired t tests and mixed effects models with repeated measures to assess associations between oxytocin, individual biosignal features, and outcomes such as stress-rest and case-control comparisons. The first participant was enrolled on December 3, 2021, and recruitment closed on December 31, 2022. Nine patient dyads and nine control dyads were recruited. Sixteen participating dyads completed follow-up assessments. The results of this study will provide preliminary evidence for the extent to which a wearable biosensor that collects physiological signals can be used to monitor OCD severity and events in youths. If we find the study to be feasible, further studies will be conducted to integrate biosensor signals output into machine learning algorithms that can provide patients, parents, and therapists with actionable insights into OCD symptoms and treatment progress. Future definitive studies will be tasked with testing the accuracy of machine learning models to detect and predict OCD episodes and classify clinical severity. ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/ct2/show/NCT05064527. DERR1-10.2196/45123.

Expected increase in health competence improves over modules of an unguided internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Internet-based cognitive-behavioural interventions (iCBT) are a valuable alternative to face-to-face psychotherapy. An unguided iCBT program has shown to be efficacious for patients with obsessive-compulsive disorder (OCD). However, the modules' mode of action is not well understood, which is the objective of the present study. Twenty-five patients with OCD who participated at the iCBT program for 8 weeks answered a questionnaire on their self-efficacy, motivation, expected increase in health competence and experiential avoidance before and after each module and were included in the present analyses. Linear mixed-effects models demonstrated that patients' expected increase in health competence improved over the course of the treatment. No within-module-specific effect was found. The iCBT program was able to improve patients' expected health competence. However, all other variables did not change. The iCBT program should be revised by focusing more strongly on the integration of the content to reduce experiential avoidance and to improve motivation.

Efficacy of internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis.

Efficacy of internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis.

Effectiveness of Internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (OCD-NET) and body dysmorphic disorder (BDD-NET) in the Swedish public health system using the RE-AIM implementation framework

ObjectivesTherapist-guided internet-delivered cognitive behaviour therapy (ICBT) is an efficacious treatment for obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), but it is unclear if the results obtained in controlled trials can be reproduced in clinical settings. We evaluated the implementation of ICBT for OCD (OCD-NET) and BDD (BDD-NET) in the Swedish public health system. MethodsConsecutive referrals to an outpatient psychiatric clinic providing ICBT, with a primary diagnosis of OCD or BDD, were included in the study. Four hundred and thirty-four participants started OCD-NET and 163 started BDD-NET. The primary outcome measures were the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the Y-BOCS for BDD (BDD-YBOCS), respectively. Participants were assessed before treatment, weekly during treatment, and after treatment. The study used the RE-AIM implementation framework, and the elements of reach, effectiveness, adoption, and implementation for the evaluation. ResultsIntention to treat analysis of the OCD-NET sample (n = 434) showed a significant decrease in OCD symptoms from pre-treatment to post-treatment (mean reduction = −8.77 [95 % CI -9.48 to −8.05] p < .001, d = 1.94 [95 % CI 1.75 to 2.13]). Forty-nine percent (95 % CI 43 % to 56 %) of the participants in OCD-NET were classified as treatment responders and 21 % (95 % CI 16 % to 27 %) were in remission. Participants in BDD-NET (n = 163) also showed a significant decrease in BDD symptoms from pre-post treatment (mean reduction = −11.37 [95 % CI -12.9 to −9.87] p < .001, d = 2.07 [95 % CI 1.74 to 2.40]) and 69 % (95 % CI 58 % to 79 %) of the participants were classified as treatment responders and 48 % (95 % CI 38 % to 58 %) were in full or partial remission. Eighty-seven percent of the participants in OCD-NET and 78 % in BDD-NET were treatment completers and participants in both treatment groups reported a high treatment satisfaction at post treatment (OCD-NET = 87 %, BDD-NET = 79 %). The most reported negative effects attributed to the treatments were transient experiences of unpleasant feelings (52 %) and anxiety (50 %). The implementation also influenced treatment delivery and dramatically decreased the mean number of patients waiting to receive face-to-face treatment at the clinic. ConclusionsOur results indicate that OCD-NET and BDD-NET are suitable treatments for implementation in a Swedish public health service.

Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities

Introduction: Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. Objective: The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. Methods: This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. Results: All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. Conclusions: I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated.

Neural correlates of emotional reactivity predict response to cognitive-behavioral therapy in obsessive-compulsive disorder

BackgroundExamining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD). MethodsTo this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT. ResultsWe found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life. LimitationsSome participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings. ConclusionsThe current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.

Therapeutic Alliance and Treatment Outcome in Cognitive Behavior Therapy for Obsessive-Compulsive Disorder.

ObjectiveTherapeutic alliance has consistently been found to predict treatment outcomes across various psychotherapies and patient diagnosis. However, the relationship between therapeutic alliance and outcome in Cognitive Behavioral Therapy (CBT) has shown mixed results. This study investigated the impact of different aspects of therapeutic alliance in CBT for Obsessive-Compulsive Disorder (OCD).MethodData from two previously completed randomized controlled trials of 208 patients with OCD and their therapists were analyzed. Therapeutic alliance was assessed at week 4 of treatment with the patient-rated and therapist-rated Working Alliance Inventory (WAI), which includes three subscales to measure alliance domains (Goal, Task and Bond). Higher WAI score reflects a better therapeutic relationship. OCD severity was rated by independent assessors at baseline and post-treatment using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Linear regression analyses were used to examine the effects of the different aspects of therapeutic alliance on treatment outcome, adjusted for baseline symptom severity.ResultsA higher total WAI score as rated by therapists significantly predicted a lower post-treatment Y-BOCS. Further, higher scores on the Goal and Task subscales of the WAI were associated with lower post-treatment severity. However, these significant outcomes reflected only small effect sizes.ConclusionsIn the treatment of OCD, the strength of the therapeutic alliance contributes to outcomes, though to a limited extent. Effective OCD treatment involves the delivery of specific therapy interventions, in the context of a strong therapeutic alliance.

Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study

Obsessive-compulsive disorder (OCD) is a treatable condition that often requires specialist care, particularly when comorbid with autism spectrum disorder (ASD). However, specialist clinics are few and typically located in large medical centers. To increase availability of evidence-based treatment for OCD in individuals with ASD, we adapted an internet-delivered cognitive behavior therapy (ICBT) protocol to suit the needs of these individuals and conducted a feasibility study (N = 22). The primary outcome was the clinician-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), administered at pre- and post-treatment as well as 3 months after treatment. ICBT was deemed acceptable and was associated with clinically significant improvements in CY-BOCS scores, corresponding to a large within-group effect size (Cohen's d = 1.33). Similarly, significant improvements were observed in most of the secondary parent- and self-rated measures. Approximately 60% of the participants were classed as treatment responders and 50% were in remission from their OCD at the 3-month follow-up. To provide a meaningful benchmark, we also analyzed data from a specialist clinic that regularly treats individuals with comorbid OCD and ASD (N = 52). These analyses indicated that specialized in-person CBT produced significantly larger effects (d = 2.69) while being markedly more resource demanding, compared to ICBT. To conclude, ICBT can be successfully adapted to treat OCD in youth with ASD and may be a viable alternative for those who do not have direct access to highly specialized treatment. Further improvements of the treatment protocol based on participant and therapist feedback are warranted, as is a formal test of its efficacy and cost-effectiveness in a randomized controlled trial.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 8–10 Years After Inpatient Treatment

Obsessive-compulsive disorder (OCD) can be effectively treated by cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Yet, little is known about the long-term effects of inpatient CBT up to one decade after treatment. Thirty patients who had been treated with 12 weeks of intensive inpatient CBT with ERP were examined 8-10 years after their stay in hospital with regard to obsessive-compulsive symptoms, secondary outcomes, and use of healthcare services. Significant (p < .001) improvements in OC symptoms with medium and large effects compared to baseline on the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) and on the Obsessive-Compulsive Inventory (OCI-R) could still be observed, with 20% of the patients reaching remission status. Continuation of exposure exercises after the inpatient stay was the sole significant factor for improved scores at follow-up. The results suggest that OCD does not necessarily take a chronic course. However, maintenance of exposure training seems to be crucial for sustained improvement.

What is the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology? A systematic literature review.

Obsessive-compulsive disorder (OCD) is one of the most debilitating health conditions in the world. There has been a vast amount of research into factors that increase the likelihood of developing OCD, and there are several explanatory models. Current cognitive models of OCD can be split into appraisal-based and self-doubt models. To date, cognitive-behavioural therapy for OCD (grounded in appraisal-based models) is the recommended treatment approach, and research into the importance of self-doubt beliefs has been somewhat neglected. This paper therefore aims to consolidate current research, utilizing a systematic review approach, to establish the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology. A systematic search was conducted based on inclusion criteria identified for this review. Papers were then individually appraised for quality and key data extracted from each paper. A total of 11 studies were included in the final sample. Fear of self and self-ambivalence were both consistently found to be significant predictors of obsessive-compulsive symptomatology. In particular, research suggests that there is a strong link between self-doubt beliefs and obsessions and obsessional beliefs related to OCD. Limitations of the review and suggestions for future research are made and applications to clinical practice discussed.

The Relative Impact of Cognitive and Behavioral Skill Comprehension and Use During CBT for Obsessive Compulsive Disorder

During cognitive-behavioral therapy (CBT) for Obsessive Compulsive Disorder (OCD), individuals learn to utilize cognitive and behavioral skills to manage their symptoms. However, it is unclear whether these CBT skills have similar effects on symptom alleviation throughout treatment. This study examined the impact of CBT skill comprehension and CBT skill frequency on OCD symptom change during CBT for OCD. Participants experiencing a primary diagnosis of OCD (N = 101) completed self-report measures of OCD symptoms, skill comprehension (e.g., using the Skills of Cognitive Therapy Questionnaire (SoCT)), and skill frequency (i.e., comparing the thought record (TR) with exposure and response prevention (ERP)) during treatment. Structural equation modelling analyses involving an integration of growth curve analysis and cross-lagged regression analysis demonstrated that skill comprehension and skill frequency trajectories are associated with OCD symptom trajectories. There was a significant cross-lagged relationship between skill comprehension and OCD symptom change, in which higher levels of skill comprehension were associated with OCD symptom alleviation. Comparable analyses of skill frequency demonstrated that higher levels of both TR frequency and ERP frequency were associated with improvements in OCD symptoms. These results demonstrate that higher levels of skill comprehension as well as skill frequency are associated with OCD symptom alleviation.

Altered network connectivity predicts response to cognitive-behavioral therapy in pediatric obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) is commonly associated with alterations in cortico-striato-thalamo-cortical brain networks. Yet, recent investigations of large-scale brain networks suggest that more diffuse alterations in brain connectivity may underlie its pathophysiology. Few studies have assessed functional connectivity within or between networks across the whole brain in pediatric OCD or how patterns of connectivity associate with treatment response. Resting-state functional magnetic resonance imaging scans were acquired from 25 unmedicated, treatment-naive children and adolescents with OCD (12.8 ± 2.9 years) and 23 matched healthy control (HC) participants (11.0 ± 3.3 years) before participants with OCD completed a course of cognitive-behavioral therapy (CBT). Participants were re-scanned after 12-16 weeks. Whole-brain connectomic analyses were conducted to assess baseline group differences and group-by-time interactions, corrected for multiple comparisons. Relationships between functional connectivity and OCD symptoms pre- and post-CBT were examined using longitudinal cross-lagged panel modeling. Reduced connectivity in OCD relative to HC participants was detected between default mode and task-positive network regions. Greater (less altered) connectivity between left angular gyrus and left frontal pole predicted better response to CBT in the OCD group. Altered connectivity between task-positive and task-negative networks in pediatric OCD may contribute to the impaired control over intrusive thoughts early in the illness. This is the first study to show that altered connectivity between large-scale network regions may predict response to CBT in pediatric OCD, highlighting the clinical relevance of these networks as potential circuit-based targets for the development of novel treatments.

OCD and COVID-19: a new frontier.

(1)To learn how to identify OCD in the context of COVID-19 and consider the differences between following government guidelines and OCD.(2)To consider the presentation of OCD in context of COVID-19, with regard to cognitive and behavioural processes.(3)Review factors to be considered when embarking on CBT for OCD during the pandemic.(4)Considerations in CBT for OCD, including weighing up costs and benefits of behavioural experiments or exposure tasks in light of our current understanding of the risks associated with COVID-19.

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.

Cost-effectiveness of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder

Economic analyses of treatments for OCD have been limited. This study analysed the comparative economic benefits and costs of an internet-based CBT (iCBT) relative to internet-based progressive relaxation therapy (iPRT) control. These were benchmarked against current estimates for face-to-face CBT (ffCBT) sourced from literature. The benefits to society of providing increased access to treatment was assessed using a cost-benefit analysis based upon productivity gains arising from treatment. Identification of the most cost-effective treatment amongst the three treatments was assessed using a cost-effectiveness analysis based upon both effectiveness as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS) and percentage of responders. The cost-effectiveness analysis showed iCBT to be the most cost effective treatment of the three analysed, followed by ffCBT based upon percentage of responders and iPRT based upon overall effectiveness of treatment. The cost-benefit analyses showed all treatment options delivered substantial benefits to society. These benefits ranged from three to thirty-five times the cost of providing treatment, depending on the assumptions used and the treatment provided, with iCBT showing the greatest ratio of benefits to costs but the ffCBT providing the greatest absolute benefits. Overall, the findings provide support for increased access to CBT intervention, for all patients with OCD; with online therapist-assisted modes of delivery as a cost-effective alternative to existing face-to-face treatments. Further work to more accurately quantify the benefits and costs resulting from CBT treatment modalities is required to support these preliminary findings.

Introduction to the Special Issue: Challenges in Treating Obsessive-Compulsive Disorder With Cognitive-Behavioral Therapy.

Cognitive-behavioral therapy (CBT) is a recommended treatment for obsessive-compulsive disorder (OCD). CBT offers specific interventions with demonstrated efficacy, including both cognitive therapy and exposure and ritual prevention (ERP). Yet, implementing these techniques with individual patients can present clinical challenges. In this special issue, expert clinicians and researchers present cases in which they addressed some common challenges in implementing CBT for OCD, including comorbid depression, poor insight, and family accommodation of symptoms in pediatric OCD. Other papers present how CBT can be tailored to specific OCD manifestations, including post-partum OCD, taboo thoughts, and relationship OCD. Other authors detail how they have augmented standard ERP with additional treatment techniques to maximize outcomes. These articles present a diverse set of case histories and specific treatment techniques that illustrate ways to maximize the effectiveness of CBT for OCD, serving as a useful guide for clinicians in practice and highlighting areas for future research.