Reducing Obsessive-compulsive Disorder Symptoms Research Articles

Internet-Based Cognitive Behavioural Treatments for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.

Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.

Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial

Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.

Safety, feasibility, tolerability, and clinical effects of repeated psilocybin dosing combined with non-directive support in the treatment of obsessive-compulsive disorder: protocol for a randomized, waitlist-controlled trial with blinded ratings.

To date, few randomized controlled trials of psilocybin with non-directive support exist for obsessive-compulsive disorder (OCD). Results and participant feedback from an interim analysis of an ongoing single-dose trial (NCT03356483) converged on the possibility of administering a higher fixed dose and/or more doses of psilocybin in future trials for presumably greater benefits. This trial aims to evaluate the safety, feasibility, tolerability, and clinical effects of two doses of psilocybin paired with non-directive support in the treatment of OCD. This trial also seeks to examine whether two doses of psilocybin lead to greater OCD symptom reduction than a single dose, and to elucidate psychological mechanisms underlying the effects of psilocybin on OCD. A randomized (1:1), waitlist-controlled design with blinded ratings will be used to examine the effects of two doses of oral psilocybin paired with non-directive support vs. waitlist control on OCD symptoms. An adaptive dose selection strategy will be implemented (i.e., first dose: 25 mg; second dose: 25 or 30 mg). This single-site trial will enroll 30 adult participants with treatment-refractory OCD. Aside from safety, feasibility, and tolerability metrics, primary outcomes include OCD symptoms assessed on the Yale-Brown Obsessive-Compulsive Scale - Second Edition (Y-BOCS-II). A blinded independent rater will assess primary outcomes at baseline and the primary endpoint at the end of the second dosing week. Participants will be followed up to 12 months post-second dosing. Participants randomized to waitlist will be rescreened after 7 weeks post-randomization, and begin their delayed treatment phase thereafter if still eligible. Written informed consent will be obtained from participants. The institutional review board has approved this trial (protocol v. 1.7; HIC #2000032623). This study seeks to advance our ability to treat refractory OCD, and catalyze future research seeking to optimize the process of psilocybin treatment for OCD through understanding relevant psychological mechanisms.Clinical trial registration: ClinicalTrials.gov, identifier NCT05370911.

Pharmacological and Psychological Treatment Have Common and Specific Effects on Brain Activity in Obsessive-Compulsive Disorder

Initial treatment for obsessive-compulsive disorder (OCD) consists of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) and/or psychological treatment with cognitive behavioral therapy (CBT). The assumption is that both treatments have different neural working mechanisms, but empirical evidence is lacking. We investigated whether these treatments induce similar or different functional neural changes in OCD. We conducted a longitudinal nonrandomized controlled trial in which thirty-four OCD patients were treated with sixteen weeks of CBT or SSRIs. Functional magnetic resonance imaging was performed before and after treatment during emotional processing (emotional face matching and symptom provocation tasks) and response inhibition (stop signal task). Twenty matched healthy controls were scanned twice with a similar time interval. Both CBT and SSRIs were successful in reducing OCD symptoms. Compared to healthy controls, treatment led to a reduction of insula activity in OCD patients during symptom provocation. The comparison between treatment groups revealed widespread divergent brain changes in the cerebellum, posterior insula, caudate nucleus, hippocampus, and occipital and prefrontal cortex during all tasks, explained by relative increases of activity following CBT compared to relative decreases of activity following SSRIs. Pharmacological and psychological treatment primarily lead to opposite changes in brain function, with a common reduction of insula activity during symptom provocation. These findings provide insight into common and specific neural mechanisms underlying treatment response, suggesting that CBT and SSRIs support recovery from OCD along partly distinct pathways. This trial is registered with NTR6575.

The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses.

Repetitive transcranial magnetic stimulation (rTMS) has been increasingly used for treating obsessive-compulsive disorder (OCD). Although several meta-analyses have explored its effectiveness and safety, there is no umbrella review specifically focused on rTMS for OCD. This umbrella review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and analyzed relevant meta-analyses on rTMS for OCD. Twenty-three articles were identified from PubMed, and after screening, 12 meta-analyses were included in the review. The studies analyzed in the meta-analyses ranged from 10 to 27, with total participants ranging from 282 to 791. The most commonly studied regions were the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and orbito-frontal cortex (OFC). The majority of the meta-analyses consistently supported the effectiveness of rTMS in reducing OCD symptoms when applied to the DLPFC and SMA. Encouraging results were also observed when targeting the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) through deep transcranial magnetic stimulation (dTMS). However, there was a high level of heterogeneity in the findings of nine out of 12 meta-analyses. In conclusion, existing evidence suggests that rTMS targeting the DLPFC and SMA consistently reduces OCD symptoms, but targeting the mPFC and ACC through dTMS shows variable results. However, the high heterogeneity in the study findings indicates a need for further research and standardization in the field.

Improvement in OCD symptoms associated with serotoninergic psychedelics: a retrospective online survey

A renewed interest in the use of psychedelics for treating obsessive compulsive disorder (OCD) has emerged in the last 20 years. But pre-clinical and clinical evidence remain scarce, and little is known about the factor determining the magnitude and persistence of the therapeutic effect. We therefore designed a retrospective online survey to explore, in the general population using psychoactive drugs, their impact on OCD symptoms. We also assessed the attitude of the participants towards the substance in term of frequency of intakes. In a sample of 174 participants, classic psychedelics were reported as the only substances effective at reducing OCD symptoms. In classic psychedelics users, symptoms reduction was associated with the intensity of acute effects, itself correlated to the dose. Reports on the persistence of the therapeutic effect varied from weeks to months, but we could not find any predicting factor. Finally, the occurrence and frequency of subsequent intakes, which seemed to be limited in our sample, were predicted by the magnitude and persistence of the therapeutic effect, respectively. Our observations support the hypothesis of classic psychedelics efficacy in reducing OCD symptoms but a careful evaluation of the persistence of this effect is still needed.

Will Transcranial Magnetic Stimulation Improve the Treatment of Obsessive-Compulsive Disorder? A Systematic Review and Meta-Analysis of Current Targets and Clinical Evidence.

Although in 2017 a repetitive transcranial magnetic stimulation (rTMS) protocol received Food and Drug Administration approval for the first time for the treatment of obsessive-compulsive disorder (OCD), which neural target and which protocol should be used for OCD are still debated. The aim of the present study was to perform a systematic review and meta-analysis of the available open and sham-controlled trials. The primary analysis included a pairwise meta-analysis (over 31 trials), and then subgroup analyses were performed for each targeted brain area. Meta-regression analyses explored the possible moderators of effect size. The pairwise meta-analysis showed a significant reduction in OCD symptoms following active rTMS (g = -0.45 [95%CI: -0.62, -0.29]) with moderate heterogeneity (I2 = 34.9%). Subgroup analyses showed a significant effect of rTMS over the bilateral pre-SMA (supplementary motor area), the DLPFC (dorsolateral prefrontal cortex), the ACC/mPFC (anterior cingulate cortex and medial prefrontal cortex), and the OFC (orbitofrontal cortex). No moderators of the effect size emerged. TMS of several brain targets represents a safe and effective treatment option for OCD patients. Further studies are needed to help clinicians to individualize TMS protocols and targets for each patient.

A Systematic Review of the Use of Acceptance and Commitment Therapy to Treat Adult Obsessive-Compulsive Disorder

The present review aims to critically evaluate available literature on the use of acceptance and commitment therapy (ACT) to treat adult obsessive-compulsive disorder (OCD) and to draw conclusions about using ACT to reduce OCD symptoms in adults with OCD. Databases (PsycINFO, PsycARTICLES, MEDLINE, and PubMed), Google Scholar, and article references were used to identify relevant studies through October 10, 2020. This review includes both peer-reviewed, published articles (n = 15) and unpublished theses and dissertations (n = 2) to increase the breadth of the review as suggested by PRISMA guidelines. Reviewed articles utilized ACT and at least one measure of OCD symptom severity. Information on methodological, measurement, statistical, and analytical characteristics of the included studies were extracted to determine the quality of the available studies and to inform the conclusions of this review. Seventeen studies (n = 17) with 336 participants from three countries were evaluated. The current evidence suggests that ACT can be used to reduce symptoms of OCD in adults. A conclusion supporting the use of ACT to reduce OCD symptoms can be made because of several strengths within this body of literature (e.g., use of validated OCD symptom measures, inclusion of treatment manuals, use of multiple assessment points, etc.). However, because a majority of the included studies are quasi-experimental and single-subject studies, more stringent research (i.e., randomized controlled trials) with large, diverse samples is needed to strengthen this conclusion. Additionally, dismantling studies exploring the components of ACT that lead to OCD symptom improvement are needed.

Effectiveness of brief daily training using a mobile app in reducing obsessive compulsive disorder (OCD) symptoms: Examining real world data of “OCD.app - Anxiety, mood & sleep”

BackgroundRandomized controlled trials (RCTs) indicate that mobile delivered training targeting OCD cognitions is effective in reducing OCD symptoms. However, interventions shown to be effective in RCTs may be less effective in real world settings. MethodsReal world data of “OCD.app - Anxiety, Mood & Sleep” users was collected from October 2020 to June 2022. Users’ OCD symptoms, trait and state mood scores were evaluated at baseline (T0; n = 46,955), payment barrier (T1; n = 13,568), and at the final level (T-final; n = 1732). ResultsDropout rates were higher for women and associated with younger age. Medium effect size reductions in OCI-R scores from T0 to T1 (Cohen's d = 0.37) and medium-large (Cohen's d = 0.66) reductions from T0 to T-final were found. Effects remained when controlling for demographic data and mood and were strongest for users with severe OCD symptoms. Clinically significant improvement (OCI-R change ≥21) was found in 16% of users with severe OCD symptoms. Although stable user traits were prominent moderators of change following short-term use, app usage indicators were more notable over longer training periods. ConclusionsReal world data supports the effectiveness of OCD.app for reducing the full range of OCD symptoms.

Quality of the therapeutic working alliance as a factor in intensive residential treatment of obsessive-compulsive disorder

Objective: Intensive residential treatment (IRT) for obsessive-compulsive disorder (OCD) includes frequent meetings with a cognitive–behavioral therapist. We examined whether this therapeutic working alliance relates to IRT outcomes. Method: Data came from a naturalistic sample of patients with OCD (n = 124) who received IRT at a specialty OCD clinic. Patients completed measures of OCD severity and well-being at admission and discharge. Both the patient and treating psychologist completed the Working Alliance Inventory-Short Form (WAI-SF). Alliance ratings were tested as predictors in models predicting outcomes (discharge scores adjusting for baseline and treatment duration) as well as logistic regression predicting treatment response (≥35% symptom reduction in OCD symptoms). Results: Patient and clinician ratings of the quality of the alliance were weakly yet significantly correlated. Patient ratings of the alliance predicted outcomes, while therapist ratings did not. Moreover, greater discrepancy between patient and client ratings predicted worse outcomes. Patient ratings of the task dimension of the alliance uniquely related to responder status. Conclusions: Patient perceptions of the working alliance, particularly as pertaining to agreement on therapeutic tasks, related to success with IRT for OCD. Further study is needed test interventions to improve task alliance as a strategy to enhance treatment.

Med Check: Psilocybin for OCD, Nuplazid Vote, and More

Med Check: Psilocybin for OCD, Nuplazid Vote, and More

Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study.

BackgroundExposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging.ObjectiveWe examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment.MethodsThe treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint.ResultsTreatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months.ConclusionsIn this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.

Management of OCD: Focus on Psychotherapy

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by distressing thoughts, images, or impulses that nearly always present with compensatory behaviors (ie, compulsions, avoidance) that are completed to neutralize distress. OCD is associated with lower quality of life and functional impairment. The recommended gold standard psychotherapy for OCD is exposure and response prevention (ERP), which can be tailored to account for complexities in treatment including comorbidities, family accommodation, differential insight, and suicidal ideation. ERP, whether delivered in-person or via telehealth, has substantial empirical support for its efficacy at reducing OCD symptoms in children, adolescents, and adults. Research has supported the use of ERP for both in-person and telehealth settings, which increases the ability of clinicians to provide services to a larger number of patients. This review will discuss psychotherapy for OCD, factors to consider during such therapies, and new options made available by rapid adaptation of telehealth. [ Psychiatr Ann. 2022;52(4)138–142]

Differential assessment of frontally-mediated behaviors between self- and informant-report in patients with obsessive-compulsive disorder following gamma ventral capsulotomy

Obsessive-Compulsive Disorder (OCD) is a debilitating disorder causing marked distress and functional impairment. While advances in behavioral and pharmacotherapies have been effective for a majority of patients with OCD, 10–30% remain treatment refractory and severely impaired. For a subset of treatment-resistant individuals with the most severe and disabling (intractable) illness, gamma ventral capsulotomy (GVC) appears effective in reducing OCD symptoms and functional impairment. However, the effects of the ventral internal capsule lesion via GVC surgery on executive function in everyday life have been minimally investigated. Examining behavioral outcomes of GVC also provides a rare opportunity to probe the functional importance of the ventral prefrontal-subcortical connections of the internal capsule white matter tract in a relatively homogenous sample of patients with comparable white matter lesions. The present study investigated changes in frontally-mediated behaviors, measured by the Frontal Systems Behavior Scale (FrSBe), following GVC in 45 individuals with severe and otherwise intractable OCD, as rated by patients themselves and family members. Linear mixed effects models revealed a significant improvement in patient self-ratings on the FrSBe after surgery, while family ratings did not significantly change. Interestingly, improvement on the FrSBe for both self and family raters was significantly correlated with improvement in OCD symptomatology post-surgery, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). At the group level, we found no evidence of decline in frontally-mediated behaviors assessed by the FrSBe as a result of focal white matter disconnection via GVC. However, we cannot rule out the possibility that placebo effects or compromised patient self-awareness or insight contributed to the significant improvement in self ratings. Our measures may also have limited sensitivity to more selective impairments that could result from a small lesion to the ventral internal capsule. The present study demonstrates the need for detailed investigation of cognitive and behavioral changes as important factors when considering GVC as a viable treatment option for patients with refractory OCD.

Developing and Examining the Effectiveness of a Cognitive Behavioral Therapy-Based Psychoeducation Practice for Reducing Obsessive-Compulsive Symptoms in Adolescents: A Mixed-Methods Study With a Turkish Sample

This study developed a cognitive behavioral therapy (CBT)-based psychoeducation practice aimed at reducing obsessive-compulsive symptom levels in adolescents in Turkey and tested its effectiveness with a mixed-methods study. After the study was constructed as a pretest-posttest control group experimental application consisting of qualitative stages. The experimental application of the study was carried out with high school students in Turkey. In the sampling process, the schools, where the study will be carried out, were determined with the cluster sampling method. The experimental and control groups were formed with 30 students with high obsessive-compulsive disorder (OCD) symptoms from these schools, and the developed CBT-based psychoeducation practice was applied to the experimental group for 12 weeks. Quantitative data were collected through the “Child Version of the Obsessive-Compulsive Inventory,” and normality analysis, t-test for dependent samples, and Single Factor Analysis of Covariance were used. Qualitative data of the study were collected through document review, session evaluation forms, and semi-structured interview protocol; content and descriptive analysis techniques were used in the analysis. It was concluded that the developed CBT-based psychoeducation application was an effective approach in reducing OCD symptoms in the Turkish adolescent sample, except for the neutralizing dimension. It was also determined that the findings obtained from the analysis during the application and the interviews after the application are parallel with the findings obtained by quantitative methods, and the qualitative and quantitative findings adequately explained the quantitative documents findings.

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high risk of developing OCD symptoms. Following initial screening (n = 924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n = 25), participants started using the application at baseline (T0), 4 min a day, for 12 days (T0–T1). Participants in the delayed-app group (dApp; n = 20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1–T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen’s d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.

Efficacy of group cognitive-behavioral therapy in adolescents with obsessive compulsive disorder: a systematic review and meta-analysis.

Objective:To evaluate the effectiveness of group cognitive-behavioral therapy (GCBT) for the treatment of adolescents with obsessive compulsive disorder (OCD).Methods:This review was registered in PROSPERO under number CRD42020158475. Five databases (PubMed, Virtual Health Library, Web of Science, Scopus, and PsycINFO) were searched. After applying the inclusion and exclusion criteria, 13 studies were analyzed in the qualitative synthesis (i.e., systematic review) and eight in the quantitative synthesis (i.e., meta-analysis). For the latter, fixed-effect modeling was used to assess the primary outcome (i.e., OCD symptoms).Results:The main findings suggest that GCBT is effective in reducing the symptoms of OCD in adolescents (d = -1.32). However, these results must be interpreted with caution, since all of the included studies showed some bias in their design.Conclusions:GCBT is effective in reducing OCD symptoms in adolescents.

A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects.

(Appeared originally in Biological Psychiatry 2019; 85:726-734) Reprinted under Creative Commons CC-BY license.

A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans

ABSTRACT Exposure and response prevention (ERP) is the gold-standard, evidence-based psychotherapy for obsessive-compulsive disorder (OCD), but few receive it. Video telehealth can increase access to ERP for OCD and may enhance the salience of exposures. This study examined the feasibility, acceptability, and preliminary effectiveness of video telehealth-delivered ERP. We conducted a pilot open trial with 11 Veterans, using mixed quantitative and qualitative methods. Treatment completers (n = 9) had significantly reduced OCD and posttraumatic stress disorder symptoms posttreatment. Patients expressed greater comfort in engaging in ERP at home than in clinics. Therapists reported that seeing patients’ home environments helped them understand their symptoms and identify relevant OCD exposures. Results suggest that video telehealth-delivered ERP is feasible and acceptable to patients and therapists and promising for reducing OCD symptoms. Future research should compare its effectiveness to usual care and evaluate patients’ preferences for treatment delivery. Abbreviations: ERP: exposure and response prevention; GAD-7: Generalized Anxiety Disorder-7 scale; OCD: obsessive-compulsive disorder; OCI-R: Obsessive-Compulsive Inventory, Revised; PCL-5: PTSD Checklist; PHQ-9: Patient Health Questionnaire; PTSD: posttraumatic stress disorder; VA: epartment of Veterans Affairs; Y-BOCS: Yale-Brown Obsessive Compulsive Scale, self report form.

Effectiviteit van behandeling van obsessief-compulsieve stoornissen bij ASS: een systematische literatuurreview

Little is known about psychological and pharmacological treatment of patients with an autism spectrum disorder (ASD) and comorbid obsessive-compulsive disorder (OCD). We systematically searched PubMed, Embase, and PsycInfo for intervention studies evaluating treatment effects for patients with concurrent diagnoses of ASD and OCD. The search yielded 6594 articles of which after sequential checks of duplicates, title, abstract and full text, eight articles could be included. One study concerned a RCT, four were before-after studies with a control group, and three remaining studies were before-after studies without a control group. All studied the effect of cognitive behavioral therapy (CBT), which appears to be generally effective in treatment of OCD in people with ASD. Further research is needed to determine whether ASD specific CBT protocols are more effective in reducing OCD symptoms than regular CBT.