Cognitive Therapy For Obsessive-compulsive Disorder Research Articles

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings.

Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. TBCT may be a valid and promising treatment for this disorder.

Hoarding

This commentary highlights areas of research during my career that have been very positively influenced by Dr. Aaron T. Beck’s work on cognitive theory, assessment, and treatment of behavioral disorders. These include collaborative efforts to develop assessment of beliefs and interpretations, as well as cognitive therapy for obsessive-compulsive disorder, and especially recent work on assessing, understanding beliefs about possessions, and cognitive behavior therapy for hoarding disorder.

Identification of belief-based subtypes in obsessive-compulsive disorder using latent profile analysis

We evaluated dysfunctional belief heterogeneity in a large sample (N = 547) of adults with obsessive-compulsive disorder (OCD) because of the central role of dysfunctional beliefs in cognitive theories of OCD and the prior identification of large OCD patient subgroups who failed to endorse these beliefs. We used a methodological approach not previously applied, latent profile analysis (LPA) because of its utility for objectively testing heterogeneity and avoiding the identification of spurious subgroups. Significant dysfunctional belief heterogeneity was found and congruent with prior studies, a two-subgroup model was supported. A large, low-beliefs subgroup was identified that included over half of our sample and that reported dysfunctional belief levels equivalent to nonclinical groups or individuals with anxiety disorders but not OCD. We tested between subgroups differences on measures of OCD symptom severity and on measures of OCD-related cognition to further elucidate subgroup characteristics. Implications for cognitive theories and cognitive therapy for OCD are discussed.

Using an Acceptance and Commitment Therapy Approach When Exposure and Cognitive Therapy Become Rituals in the Treatment of Obsessive-Compulsive Disorder.

Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement following 11 sessions of ERP. Likely reasons for the relapse and strategies for enhancing ERP to achieve better long-term treatment outcomes are discussed from the perspective of acceptance and commitment therapy (ACT). These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the use of cognitive therapy for OCD.

Mindfulness-based Cognitive Therapy for Obsessive-Compulsive Disorder: A Pilot Study.

Cognitive-behavioral therapy (CBT) is the first-choice intervention for obsessive-compulsive disorder (OCD); however, a notable proportion of patients either do not respond to treatment or relapse after CBT. Mindfulness-based treatment has been suggested as an alternative or complementary therapeutic strategy for OCD. However, only a few studies have focused on its application in clinical samples. To evaluate the impact of a new treatment, called "Mindfulness-based Cognitive Therapy for OCD." It is an 11-session manualized group intervention that integrates elements of CBT, mindfulness, compassion-focused therapy, and acceptance and commitment therapy. The program was delivered to 35 patients with a primary diagnosis of OCD. Participants demonstrated good adherence to the intervention. There was a significant reduction in mean total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-TS) (P<0.001; Cohen d=-0.72). One third of the participants (n=13) showed at least a 25% reduction on the Y-BOCS-TS, and 40% of the sample (n=14) were assigned to a lower Y-BOCS severity category after treatment. Significant changes were also found in depression (P<0.001; d=-0.80), worry (P<0.001; d=-0.79), alexithymia (P<0.01; d=-0.41), dissociation (P<0.05; d=-0.46), and general psychopathology (P<0.001; d=-0.58). Repeated measures linear mixed models showed that OCD symptom reduction was associated with an increase in mindfulness skills, in particular on the acting with awareness (P=0.006), nonjudging (P=0.001), and nonreactivity (P=0.001) facets. Overall, these findings are promising and they suggest that randomized controlled studies be conducted to test the effectiveness of this new treatment program for this challenging and disabling mental disorder.

Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder

The present study sought to identify predictors of outcome for a comprehensive cognitive therapy (CT) developed for patients with obsessive-compulsive disorder (OCD). Treatment was delivered over 22 sessions and included standard CT methods, as well as specific strategies designed for subtypes of OCD including religious, sexual, and other obsessions. This study of 39 participants assigned to CT examined predictors of outcomes assessed on the Yale-Brown Obsessive Compulsive Scale. A variety of baseline symptom variables were examined as well as treatment expectancy and motivation. Findings indicated that participants who perceived themselves as having more severe OCD at baseline remained in treatment but more severe symptoms were marginally associated with worse outcome for those who completed therapy. Depressed and anxious mood did not predict post-test outcome, but more Axis I comorbid diagnoses (mainly major depression and anxiety disorders), predicted more improvement, as did the presence of sexual (but not religious) OCD symptoms, and stronger motivation (but not expectancy). A small rebound in OCD symptoms at 1-year follow-up was significantly predicted by higher scores on personality traits, especially for schizotypal (but not obsessive-compulsive personality) traits. Longer treatment may be needed for those with more severe symptoms at the outset. CT may have positive effects not only on OCD symptoms but also on comorbid depressive and anxious disorders and associated underlying core beliefs. Findings are discussed in light of study limitations and research on other predictors.

Cognitive Therapy for Obsessive Compulsive Disorder

Cognitive therapy for Obsessive-Compulsive Disorder (OCD) may be at least as effective and less stressful as the current psychological treatment of choice, exposure and response prevention (ERP). Cognitive therapy studies will be reviewed and a case example used to illustrate specific cognitive treatment techniques.

Integrative cognitive therapy for obsessive-compulsive disorder: A focus on multiple schemas

This paper describes integrative cognitive therapy for obsessive-compulsive disorder (OCD), which focuses on schemas. This treatment was developed by Sookman, Pinard, and Beauchemin (1994) for patients resistant to existing approaches. Multiple cognitive domains and levels of cognition, ranging from appraisals to core beliefs, are targeted. In addition to targeting domains such as inflated responsibility, perfectionism, and overimportance of thoughts (Obsessive Compulsive Cognitions Working Group, 1997), this approach also targets domains that the authors ( Sookman & Pinard, 1995 ) have proposed to be relevant to OCD: vulnerability; response to unpredictability, newness, and change; and view of response to strong affect. Developmental theory, role of attachment experiences, notion of schemas, emotional-interpersonal foci, and the structural dimension are integrated in the conceptualization and treatment of each case. Change in OCD symptoms, secondary depression, and dysfunctional cognitions are reported for seven treatment-resistant cases. On average, symptoms improved from a moderately severe to subclinical level. In some cases the strength of dysfunctional beliefs across multiple domains was reduced to the normal range. Preliminary results support the use of this integrative approach for patients resistant to existing approaches.

Continuing education quiz: Integrative cognitive therapy for obsessive-compulsive disorder: Focus on multiple schemas (Sookman & pinard, pp. 351–362)

Continuing education quiz: Integrative cognitive therapy for obsessive-compulsive disorder: Focus on multiple schemas (Sookman & pinard, pp. 351–362)

Cognitive therapy for obsessive-compulsive disorder

This paper discusses three cognitive models for the obsessive-compulsive disorder (OCD). Further, a cognitive formulation of OCD which stresses the importance of the perception of danger and responsibility is described. Several specific cognitive interventions, which address the estimation of catastrophes and the perception of personal responsibility, are presented and illustrated with patient material. Furthermore, problems with cognitive therapy with OCD patients are described and some solutions for these pitfalls are discussed. Finally, the findings of controlled studies into cognitive therapy with OCD are given.