Effective Treatment For Obsessive-compulsive Disorder Research Articles

A randomized double-blinded sham-controlled trial of α electroencephalogram-guided transcranial magnetic stimulation for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a highly prevalent and devastating psychiatric condition. Repetitive transcranial magnetic stimulation (rTMS) is a potential and non-invasive treatment for OCD. Diverse efficacies of rTMS have been reported in different locations or frequencies of the stimulation. The main objective of this study was to assess the treatment effect for OCD with alpha electroencephalogram (αEEG)-guided TMS over dorsal lateral prefrontal cortex bilaterally. There were 25 OCD patients in the αTMS treatment group and 21 OCD patients in the sham control group. Each subject received 10 daily treatment sessions (5 days a week). The αTMS group had significant reduction in scores of Yale-Brown Obsessive Compulsive Scale and Hamilton Rating Scale for Anxiety (HAMA) compared with the control group at the end of 2-week treatment and 1-week follow-up. Analysis of variance with repeated measures was used to test the effects between the two groups. Significant difference in scores of obsession and HAMA were found between the two groups after treatment. No significant difference in scores of Hamilton Rating Scale for Depression was found between the two groups after the treatment, but statistical significance was shown at the end of 1-week follow-up. αEEG-guided TMS may be an effective treatment for OCD and related anxiety. Delayed response to αTMS in depression suggests that it might be secondary to the improvement of primary response in OCD and anxiety.

Development of Nursing Guidelines for Inpatients with Obsessive-Compulsive Disorder in Line with the Progress of Cognitive Behavioral Therapy: A Practical Report

Cognitive behavioral therapy (CBT) is widely regarded as an effective treatment for obsessive-compulsive disorder (OCD) and is usually provided on an outpatient basis. A minority of individuals need a more intensive/ inpatient service, which is particularly important for patients who cannot be managed as outpatients owing to the nature or extent of their symptoms. Inpatient treatment is generally provided by a multidisciplinary team and psychiatric nurses play a specific and prominent role as they are afforded a unique assessment and intervention opportunity by virtue of their 24-hour presence on the unit. However, there are few facilities, reports of multidisciplinary approaches, or descriptions of the role of nursing staff as cotherapists for CBT-oriented treatment of inpatients with OCD. The present paper therefore reports the developed nursing guidelines for inpatients with OCD in line with the progress of CBT at Chiba University Hospital in the context of Japan being a country in which CBT is under development. In addition, availability of the guidelines, better means of managing severe OCD and key issues for dissemination of CBT in Japan are discussed.

Effects of chronic fluoxetine treatment on serotonin 1B receptor-induced deficits in delayed alternation

Obsessive-compulsive disorder (OCD) patients show overactivation of the orbitofrontal cortex and deficits in cognitive tasks that require proper orbitofrontal functioning including delayed alternation tests of spatial working memory. We recently showed that OCD-like behavior is induced in mice by activating orbitofrontal serotonin 1B receptors (5-HT1Bs). However, the role of 5-HT1Bs in delayed alternation remains unclear. We examined the effects of 5-HT1B receptor activation on delayed alternation task (DAT) performance. We also assessed the ability of an effective OCD treatment, fluoxetine, to prevent 5-HT1B-induced deficits in DAT performance. Mice were tested on the DAT after acute treatment with saline, 3 or 6mg/kg RU24969 (5-HT1B/1A agonist), 0.3 or 3mg/kg 8-OH-DPAT (5-HT1A agonist), or co-injection with 3mg/kg RU24969 and 5mg/kg GR127935 (5-HT1B/1D antagonist). Separate mice were pretreated chronically (28days) with 10mg/kg fluoxetine and then tested on the DAT after acute treatment with 3mg/kg RU24969, 0.3mg/kg 8-OH-DPAT, or saline. Both doses of RU24969 decreased accuracy and increased latency on the DAT, and GR127935 blocked RU24969-induced effects on accuracy. The 0.3mg/kg 8-OH-DPAT did not affect the DAT performance, whereas 3mg/kg increased omissions on the DAT. Finally, RU24969-induced DAT deficits were absent in fluoxetine-pretreated mice. We show that 5-HT1B receptor activation disrupts DAT performance in mice, and chronic fluoxetine pretreatment blocks these 5-HT1B-induced deficits. Our findings suggest that 5-HT1B receptors play an important role in modulating orbitofrontal-dependent delayed alternation. Moreover, 5-HT1B-induced DAT deficits may provide a mouse model for DAT deficits in OCD.

Deep brain stimulation for obsessive–compulsive disorder is associated with cortisol changes

Deep brain stimulation (DBS) is an effective treatment for obsessive-compulsive disorder (OCD), but its mechanism of action is largely unknown. Since DBS may induce rapid symptomatic changes and the pathophysiology of OCD has been linked to the hypothalamic-pituitary-adrenal (HPA) axis, we set out to study whether DBS affects the HPA axis in OCD patients. We compared a stimulation ON and OFF condition with a one-week interval in 16 therapy-refractory OCD patients, treated with DBS for at least one year, targeted at the nucleus accumbens (NAc). We measured changes in 24-h urinary excretion of free cortisol (UFC), adrenaline and noradrenaline and changes in obsessive-compulsive (Y-BOCS), depressive (HAM-D) and anxiety (HAM-A) symptom scores. Median UFC levels increased with 53% in the OFF condition (from 93 to 143nmol/24h, p=0.12). There were no changes in urinary adrenaline or noradrenaline excretion. The increase in Y-BOCS (39%), and HAM-D (78%) scores correlated strongly with increased UFC levels in the OFF condition. Our findings indicate that symptom changes following DBS for OCD patients are associated with changes in UFC levels.

A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder.

Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and 3-month follow-up by an assessor who was unaware of treatment conditions: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. Treatment Evaluation Inventory was completed at posttreatment. ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pretreatment = 24.22, posttreatment = 12.76, follow-up = 11.79; PRT pretreatment = 25.4, posttreatment = 18.67, follow-up = 16.23) and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT (clinical response rates: ACT posttreatment = 46%-56%, follow-up = 46%-66%; PRT posttreatment = 13%-18%, follow-up = 16%-18%). Quality of life improved in both conditions but was marginally in favor of ACT at posttreatment. Treatment refusal (2.4% ACT, 7.8% PRT) and dropout (9.8% ACT, 13.2% PRT) were low in both conditions. ACT is worth exploring as a treatment for OCD.

P.4.a.004 A comparison of different types of obsessions due to brain damage

La thérapie cognitive et comportementale (TCC) est reconnue comme efficace pour soigner le trouble obsessionnel compulsif (TOC). Pour maximiser son efficacité, nous avons conçu, dans une démarche participative associant patients et thérapeutes, une TCC « expérimentale » définie par l’adjonction d’un outil psychopédagogique informatisé basé sur une tâche de vérification. Cette étude randomisée en double insu inclut 35 patients atteints de TOC de vérification suivis en TCC « standard » ou « expérimentale » sur le plan clinique et neurocomportemental grâce à une tâche originale de provocation de symptômes avec des photographies neutres, anxiogènes génériques et anxiogènes personnalisées. Les thérapeutes ont apprécié la dimension psychopédagogique de l’outil informatisé. Les deux TCC ont entraîné une amélioration des symptômes équivalente et significative et une diminution de l’anxiété induite par les photographies anxiogènes personnalisées. La réponse à mi-thérapie était prédictive de l’amélioration finale. L’outil informatisé peut fournir un adjuvant thérapeutique bien accepté même s’il n’augmente pas le gain thérapeutique. La tâche de provocation de symptômes utilisant des images personnalisées permit de mettre en évidence l’évolution parallèle des symptômes et des marqueurs neurocomportementaux au cours des TCC. Malgré la difficulté d’augmenter l’efficacité d’une thérapie fondée sur les preuves, les résultats observés à mi-thérapie suggèrent d’explorer précocement les ajustements possibles des stratégies thérapeutiques.Cognitive behavioral therapy (CBT) is recognized as an effective treatment for obsessive-compulsive disorder (OCD). To maximize its effectiveness, we designed an “experimental” CBT defined by the addition of a computerized psychoeducative tool.In a participative process involving patients through meetings of the French OCD association (AFTOC) and therapists through methodological workshops, we built a therapeutic tool from an experimental checking task. This task, which had been published in an earlier work, was adapted for its psychoeducative dimension. We here report on a randomized double-blind trial which included 35 patients with a moderate to severe OCD (Yale-Brown obsessive-compulsive scale, YBOCS between 16 and 25) predominant checking symptoms, no comorbidities, and 2-month stabilized or no treatment. Patients were randomly assigned to either “standard” versus “experimental” CBT. Both therapies were conducted by four CBT-experienced therapists specialized in OCD through weekly individualized sessions over 3 months. Therapy sessions of the experimental CBT were conducted as the standard CBT except for a short exercise with the computerized psychoeducative tool performed by the patient and debriefed with the therapist at the end of the sessions. Patients were assessed before, during, after therapy and again 6 months later using standard clinical tools and a neurobehavioral assessment based on an original symptom-provocation task with anxiety ratings including three types of photographs: neutral, generic inducing obsessions (e.g., doorknobs, electric wires…) and personalized (taken by the patients in their own environment).Clinically, “standard” and “experimental” CBT resulted in a significant but equivalent improvement (48% vs 45% reduction of the Y-BOCS score; P = 0.36; d = 0.12). Therapists were satisfied with the psychoeducative dimension of the computerized psychoeducative tool but reported variable acceptance across patients. Patients appreciated its usability. The clinical improvement was associated with a reduction of the task-induced anxiety (r = 0.42, P < 0.05), especially towards personalized items (−28,2% vs −20.41% for generic and −6.24% for neutral photographs, P < 0.001). Mid-therapy response level was predictive of the final improvement (r = 0.82, P < 0.001).The computerized tool may provide a well-accepted therapeutic adjuvant even though it doesn’t improve the therapeutic effect. Using a personalized symptom-provocation task reveals the parallel evolution of symptoms and neurobehavioral markers through CBT. Despite the difficulty of improving an evidence-based therapy, mid-therapy results call for investigating the possible adjustments of treatment strategies at an early stage.

Group cognitive behavioural therapy for obsessive–compulsive disorder: a systematic review and meta‐analysis

Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive-compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta-analysis of the effectiveness of group CBT/ERP for OCD. A systematic literature search was conducted and studies were meta-analysed by means of the Cochrane Review Manager Program with measures of i) pre- to post-effect sizes (ES) and ii) between-group ES in comparison with different control conditions. Outcome was primarily measured on the Y-BOCS and ES was calculated in the form of Cohens d. Thirteen trials were included in the meta-analysis. The overall pre-post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT. Group CBT is an effective treatment for OCD, but more studies are needed to compare the effectiveness of group and individual treatment formats.

The More You Do It, the Easier It Gets: Exposure and Response Prevention for OCD

This manuscript is one in a series of invited papers to this journal. The purpose of the series is to highlight and discuss the similarities and differences between various behavioral and cognitive-behavioral approaches to the treatment of obsessive-compulsive disorder (OCD). The first article in this series (Twohig & Whittal) describes the case of “Caroline” upon which the current manuscript is based. We approach the case from a cognitive-behavioral orientation with exposure and ritual prevention (EX/RP) as the primary therapeutic approach. We highlight the use of EX/RP because of the considerable body of empirical evidence showing that EX/RP is an efficacious treatment for both adult and pediatric OCD. Using the provided case vignette, we outline a rationale for EX/RP and describe how EX/RP might be used to treat Caroline’s OCD. We begin by discussing the theoretical underpinnings for EX/RP and providing a rationale for treatment. We then briefly discuss the rich extant literature supporting EX/RP as an effective treatment for OCD. We then provide a detailed case conceptualization and description of the treatment. We conclude with barriers commonly encountered during EX/RP.

A Unique Psychotherapy–Pharmacotherapy Synergism

Exposure and response prevention is the most effective treatment for obsessive-compulsive disorder (OCD). However, at least one fourth of patients

Cognitive‐behavioral group therapy for obsessive–compulsive disorder: a 1‐year follow‐up

The aim of this study was to evaluate the results of cognitive-behavioral group therapy (CBGT) for obsessive-compulsive disorder (OCD) over a 1-year follow-up period. Forty-two OCD patients, who completed 12 sessions of CBGT, were followed for 1 year. Measures of the severity of symptoms were obtained at the end of the acute treatment and at 3, 6, and 12 months post-treatment using the Yale-Brown obsessive-compulsive scale (Y-BOCS) and the clinical global impression (CGI). The reduction in the severity of symptoms observed at the end of the treatment was maintained during 1 year (F2,41=1.1; P=0.342). Eleven patients (35.5%) relapsed in the follow-up period. The intensity of improvement (log rank=12.97, GL=1, P=0.0003) and full remission (log rank=6.17; GL=1; P=0.001) were strong predictors for non-relapsing. The CBGT is an effective treatment for OCD and its results are maintained for 1 year. However, further long-term randomized controlled trials are needed in order to confirm this finding.

Bupropion for Patients With Obsessive-Compulsive Disorder

In the present study, we examined the efficacy of bupropion for patients with obsessive-compulsive disorder (OCD). Twelve patients with OCD according to DSM-IV criteria were included in an open trial with bupropion, maximum dosage 300 mg per day, during 8 weeks. The primary efficacy parameter was the Yale-Brown Obsessive Compulsive Scale (YBOCS). A responder was defined by a reduction in score on the YBOCS of > or = 25%. Data were collected from February 2003 to July 2003. An intent-to-treat analysis using the last observation carried forward demonstrated that bupropion had no mean effect on OCD symptoms (mean YBOCS decrease was 1.1 +/- 9.6). Four patients improved, with a mean decrease on the YBOCS of 31%, and 2 of them met responder rate criteria. Eight patients experienced an exacerbation of OCD symptoms, with a mean increase on the YBOCS of 21%. Bupropion is not an effective treatment for OCD, but the bimodal distribution of the effect supports the notion that dopamine might be involved in the pathophysiology of OCD.

A Psychodynamic Clinician’s Foray into Cognitive-Behavioral Therapy Utilizing Exposure-Response Prevention for Obsessive-Compulsive Disorder

Research suggests that, by itself or as an adjunct to pharmacotherapy, cognitive-behavioral therapy (CBT) involving exposure with response prevention (ERP) is an effective treatment for Obsessive-Compulsive Disorder (OCD). However, there is a shortage of clinicians trained in this form of therapy. Although many psychodynamic clinicians treat individuals with OCD using traditional therapy that may assist them with their relationships, there is little evidence that such treatment is effective in ameliorating the OCD symptoms. As there is a clear need for more clinicians trained in CBT for OCD, it may be possible for practitioners trained in psychodynamic or other modalities to learn ERP. Such cross-theoretical training involves a number of challenges. These include the therapist's own anxiety about ERP, understanding resistance, and reconsidering therapeutic boundaries. The first author describes his experiences as a psychodynamically-trained psychologist venturing into ERP in an attempt to demonstrate that although there are barriers they are not insurmountable.

A Review of Pharmacologic Treatments for Obsessive-Compulsive Disorder

Objective: Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments. Methods: A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included. Results and discussion: The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.

Cognitive‐Behavioral Therapy for Children and Adolescents with Obsessive‐Compulsive Disorder

291 Selected by experts as the treatment of choice for youngsters, cognitive-behavioral therapy (CBT) has emerged as a safe, viable, and effective treatment for obsessivecompulsive disorder (OCD) among children and adolescents. Yet, most children with OCD do not receive CBT, at least in part due to the shortage of clinicians who are well versed in managing the unique challenges that arise in the treatment of children. This paper reviews developmental factors that complicate the diagnosis and treatment of OCD in youngsters; it discusses appropriate adaptations of CBT protocols for children; and it presents the application of CBT for children and adolescents, using a developmentally sensitive protocol that is flexible and feasible in clinical settings: RIDE Up and Down the Worry Hill. Illustrated is the use of this protocol with a 15-year-old girl with forbidden thoughts and praying rituals, and a 6-year-old boy with fears of harm and reassurance-seeking rituals. Future directions for making CBT available and accessible to children with OCD are discussed. [Brief Treatment and Crisis Intervention 3:291–306 (2003)]

A review of pharmacologic treatments for obsessive-compulsive disorder.

Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments. A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included. The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.

Treating obsessive-compulsive disorder with exposure and response prevention.

Exposure and Response (ritual) Prevention (EX/RP) for obsessive-compulsive disorder (OCD) is a behaviorally based treatment that is the most effective treatment available for most patients with OCD. In this paper, we will provide a brief description of OCD and outcome data on EX/RP, followed by discussion of the procedures and techniques involved in EX/RP which include imaginal exposure, in vivo exposure, and ritual prevention. ********** OCD Obsessions are intrusive thoughts, images, or impulses that keep coming back to people and that do not make sense. Some common obsessions include fear of contamination, fear of harm to self or others, fear of sin or immorality (also known as scrupulosity), intrusive sexual thoughts, a need for symmetry or exactness, and fear of losing things or throwing things away. Compulsions are behaviors or acts which people feel driven to perform and have difficulty resisting. Common compulsions include washing, checking, reviewing, hoarding, reassurance seeking, and mental neutralizing. Compulsions, whether overt behaviors or are meant to alleviate the distress brought on by obsessional thoughts and/or to prevent bad things from happening (e.g., patients with contamination obsessions wash their hands to prevent themselves from getting ill). Most patients tend to have more than one type of obsession or compulsion. When patients engage in an hour or more of obsessions or compulsions in a day, or if they are distressed or impaired due to these symptoms, then the patient is considered to have OCD. EX/RP Effective treatment for OCD must involve both exposure and ritual prevention. Exposure involves confronting situations, objects, and thoughts that evoke anxiety or distress because they are unrealistically associated with danger. Response (ritual) prevention is conceptualized as blocking avoidance or escape from feared situations. By encouraging the individual to remain in the feared situation without any avoidance behaviors, EX/RP affords patients the opportunity to learn that their fears are unrealistic. It is essential that clinicians and patients understand why it is so important to do exposure and ritual prevention together. Many patients would not mind confronting a feared stimulus (e.g., touching something contaminated) if they could then engage in rituals (e.g., handwashing). Rachman and his colleagues (see Rachman & Hodgson, 1980) showed that exposure to cues that trigger obsessions increase anxiety and discomfort and that ritualistic behavior led to a decrease in anxiety and discomfort. When patients were exposed to obsessional cues, but were prevented from engaging in rituals, anxiety and discomfort decreased over time. When patients were then exposed to their obsessional cues again, the urge to ritualize had decreased as compared to the previous trial. This decrease in urge to ritualize did not occur if patients continued to engage in rituals in response to obsessional cues. Foa and colleagues (1984) showed further evidence for the importance of using both exposure and ritual prevention in the treatment of OCD. In this study, patients with OCD were randomly assigned to receive either exposure alone, ritual prevention alone, or combined EX/RP. The component treatments seemed to have unique effects on OCD symptoms--ritual prevention led to reduction in compulsions and exposure led to reduction in the anxiety response to feared stimuli. Not surprisingly then, the combined treatment was found to be superior to the component treatments, with patients in this group showing the greatest reductions in both anxiety and compulsions. EX/RP treatment programs have gained empirical support, with both adults (Foa, Liebowitz, & colleagues, in preparation) and children (deHaan et al., 1998) treated with EX/RP showing more improvement in OCD symptoms than those treated with medication. …

Telephone-Administered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder - particularly those living in rural areas - do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.

Treatment of scrupulous obsessions and compulsions using exposure and response prevention: A case report

Cognitive-behavioral therapy by exposure and response prevention (EX/RP) is an effective treatment for obsessive-compulsive disorder (OCD). However, patients who have religious obsessions and compulsions (scrupulosity) introduce concerns not commonly encountered when treating individuals with other types of OCD symptoms. The present case history describes the successful use of EX/RP for a patient with scrupulosity. Behavioral and cognitive symptoms of OCD responded to treatment and remained improved at 6-month follow-up. Special considerations in presenting the rationale for using exposure-based interventions, and in developing exposure exercises for these types of symptoms, are discussed in detail.

Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder

Serotonin reuptake inhibitors appear to be uniquely effective treatments for obsessive-compulsive disorder (OCD). This double-blind, placebo-controlled study was the first trial to assess the efficacy of the most selective of the serotonin reuptake inhibitors, citalopram, in OCD. A total of 401 patients were randomized to receive citalopram 20, 40 or 60 mg/day or placebo for 12 weeks. All three doses of citalopram were significantly more effective than placebo measured on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) change score (P < 0.01). The highest response rate, defined as 25% improvement in Y-BOCS entry score, was observed in the 60 mg group (65%). This compared with 52% and 57.4% in the 40 mg and 20 mg groups. Response rate on placebo was 36.6% (P < 0.05 for all three doses of citalopram compared to placebo). There was no significant difference between the individual doses of citalopram. An advantage was seen for citalopram on the Sheehan Disability Scale compared with placebo (P < 0.05 on all three citalopram groups versus placebo for both the work situation and the family life and home responsibilities and P < 0.05 on citalopram 60 mg and 20 mg versus placebo for the social life and home activities). Citalopram was well tolerated; only 4 to 6 patients in each dose group discontinued the study prematurely due to adverse events.

Group behavioral therapy of obsessive‐compulsive disorder: Seven‐ vs. twelve‐week outcomes

Previous research has demonstrated that individualized behavioral exposure and response prevention therapy is an effective treatment for Obsessive-Compulsive Disorder. In our prior preliminary report, 7-week group exposure and response prevention therapy was also found effective in reducing obsessions and compulsions. The present report describes a larger sample (N=113) of treatment seeking obsessive-compulsives who received group behavioral therapy. As before, group exposure and response prevention significantly improved ratings of obsessions, compulsions, and depression. These improvements were maintained at 3-month and long-term follow-up. A sub-sample of patients who received 12 weeks of treatment had outcomes at the end of the group and at follow-up that did not significantly differ from those who received 7 weeks of treatment. These results confirm the efficacy of a 7-week behavioral treatment program administered in a group format. Depression and Anxiety 13:161–165, 2001. © 2001 Wiley-Liss, Inc.