Reduction In Obsessive-compulsive Symptoms Research Articles

Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study

Background/ObjectiveObsessive compulsive disorder is a disorder of special relevance in mental health, however, not all patients respond adequately to traditional intervention systems. The present work aims to study the usefulness of mindfulness-based interventions in patients with obsessive compulsive disorder. MethodAn exhaustive search of the literature between 1996 and 2021 allowed us to locate 11 published articles. The effect size was the pretest-posttest standardized mean change calculated for obsession-compulsion, as well as depression symptoms and conscious coping. Resultshe results showed mean effect sizes for mindfulness in the reduction of obsessive-compulsive symptoms (d + = 0.648) and, to a lesser extent, depression (d + = 0.417) and the improvement in Mindfull coping (d + = 0.509). There was no significant decrease in effect size when mindfulness was applied in patients with residual symptoms from previous treatments. ConclusionsThese results are promising regarding the usefulness of the application of intervention programs based on mindfulness in people with obsessive compulsive disorder, both as an alternative option and as a complementary treatment to more traditional intervention formats.

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.

Four-six year clinical follow-up of deep brain stimulation for obsessive compulsive disorder

BackgroundOver the past 20 years a number of robust studies have established the clinical effectiveness and safety of Deep brain stimulation (DBS) in adults with profound multi-treatment-refractory obsessive-compulsive disorder (OCD). However long term (>12 months) outcomes with this novel neurosurgical intervention are still inadequately reported. Our group conducted the first UK study of DBS in OCD between 2013-2017. All participants in our trial achieved a responder status at 15 month endpoint and the main results were reported in 2019. A specialist multidisciplinary clinic was established after the trial to provide life-long aftercare in the form of scheduled clinical and hardware reviews. Here we are reporting a preliminary analysis of the long-term clinical, functional and social outcomes from this cohort.MethodLong term follow-up clinical data (15–75 months, 2015 onwards) were prospectively collected from the participants who were enrolled in the original MRC-UCL pilot study of DBS for OCD. DBS parameters, battery health and status, social circumstances, mental state and medication adjustments were noted alongside the outcome measures of YBOCS at clinical follow-up encounters. Additional ratings of GAF, SDS and certain qualitative measures were recorded at least once every year since initial study completion.ResultFive out of six participants continued with DBS treatment and kept responder status. One participant had his DBS switched off and hardware removed. One participant had multiple hospital admissions to manage comorbidity progression to primary condition. One participant had OCD severity scores revised upwards despite continuing gains in QoL. Secondary outcomes generally matched the 15 month end point of initial trial. All participants experienced minor to major changes in their relationships with partners or family. Qualitative feedback indicated that DBS was well tolerated by 5/6 subjects but the burden of specialist follow-up remained significant.ConclusionOur long term follow-up data indicate that DBS is safe and conferred a sustained long-term benefit in reduction of obsessive-compulsive symptoms. A non-trivial burden of checking and maintenance of implanted hardware, comorbidity-unmasking following successful OCD treatment, perceived ‘burden of normality’ by the participant, need for life-long follow-ups with specialist multidisciplinary team including DBS nurses, highly specialist psychiatrists from National OCD service, neuropsychiatrists, neurologists and neurosurgeons partially counterbalances the gains offered by this treatment. Overall DBS offers a safe, effective and enduring alternative to participants who do not respond to any other form of OCD treatment and do not wish to undergo ablation surgery.

High-frequency neuromodulation improves obsessive-compulsive behavior.

Nearly one billion people worldwide suffer from obsessive-compulsive behaviors1,2, yet our mechanistic understanding of these behaviors is incomplete, and effective therapeutics are unavailable. An emerging perspective characterizes obsessive-compulsive behaviors as maladaptive habit learning3,4, which may be associated with abnormal beta-gamma neurophysiology of the orbitofrontal-striatal circuitry during reward processing5,6. We target the orbitofrontal cortex with alternating current, personalized to the intrinsic beta-gamma frequency of the reward network, and show rapid, reversible, frequency-specific modulation of reward- but not punishment-guided choice behavior and learning, driven by increased exploration in the setting of an actor-critic architecture. Next, we demonstrate that chronic application of the procedure over 5 days robustly attenuates obsessive-compulsive behavior in a non-clinical population for 3 months, with the largest benefits for individuals with more severe symptoms. Finally, we show that convergent mechanisms underlie modulation of reward learning and reduction of obsessive-compulsive symptoms. The results contribute to neurophysiological theories of reward, learning and obsessive-compulsive behavior, suggest a unifying functional role of rhythms in the beta-gamma range, and set the groundwork for the development of personalized circuit-based therapeutics for related disorders.

Personalised 360o video exposure therapy for the treatment of obsessive-compulsive disorder: A single case study

Summary Objective Between 40 and 60% of patients with obsessive-compulsive disorder (OCD) are resistant to first-line treatments, including exposure and response prevention techniques. Those are likely to benefit from the rise of virtual reality (VR). However, very few studies have been conducted on the use of VR in OCD with several limitations including a lack of ecological validity. This proof of concept study aims to assess the feasibility and therapeutic potential of a personalised exposure protocol using immersive video. Methods This protocol was applied to a patient suffering from severe and resistant OCD and consisted of 15 weekly sessions of exposure via a VR headset to 360° immersive videos filmed from the subject's viewpoint in their own environment. Results Besides the high acceptability of the immersive device, our patient exhibited a therapeutic response with a reduction in emotional responses measured by skin conductance recording, a reduction in obsessive-compulsive symptoms and an improvement in quality of life. Conclusions This study provided promising results in a patient initially refractory to conventional treatments. Replication of these results would place personalised immersive 360o video exposure as a technique of choice in the therapeutic arsenal for OCD due to its cost-effectiveness and high acceptability.

Political Ideology and Precautionary Reasoning: Testing the Palliative Function of Right-Wing Ideology on Obsessive-Compulsive Symptoms

Precautionary models of political ideology suggest that people on the right are motivated by needs to neutralize threats in everyday life more than those on the left. This article examines whether this ideological difference extends to needs to engage in everyday precautionary actions as indexed by obsessive-compulsive symptoms. Across four samples (including a nationally representative sample), we find that stronger obsessive-compulsive symptoms are associated with more right-wing ideological preferences, particularly for social issues. Using a communication experiment, we find that exposure to real-world policy assurances from the Republican Party (i.e., the U.S. conservative party) provides a small, most likely short-lived reduction in obsessive-compulsive symptoms among Americans. We discuss how these findings shed light on the key paradox about the psychology of right-wing ideology: how right-wing ideology can function to reduce insecurity while people on the right still have higher levels of insecurity.

Six-Nine Year Follow-Up of Deep Brain Stimulation for Obsessive-Compulsive Disorder.

ObjectiveDeep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) region has shown promise as a neurosurgical intervention for adults with severe treatment-refractory obsessive-compulsive disorder (OCD). Pilot studies have revealed improvement in obsessive-compulsive symptoms and secondary outcomes following DBS. We sought to establish the long-term safety and effectiveness of DBS of the VC/VS for adults with OCD.Materials and MethodsA long term follow-up study (73–112 months) was conducted on the six patients who were enrolled in the original National Institute of Mental Health pilot study of DBS for OCD. Qualitative and quantitative data were collected.ResultsReduction in OCD symptoms mirrored the one-year follow-up data. The same four participants who were treatment responders after one year of treatment showed a consistent OCD response (greater than 35% reduction in Yale Brown Obsessive Compulsive Scale (YBOCS)). Another subject, classified as a non-responder, achieved a 26% reduction in YBOCS score at long term follow-up. The only patient who did not achieve a 25% or greater reduction in YBOCS was no longer receiving active DBS treatment. Secondary outcomes generally matched the one-year follow-up with the exception of depressive symptoms, which significantly increased over the follow-up period. Qualitative feedback indicated that DBS was well tolerated by the subjects.DiscussionThese data indicate that DBS was safe and conferred a long-term benefit in reduction of obsessive-compulsive symptoms. DBS of the VC/VS region did not reveal a sustained response for comorbid depressive symptoms in patients with a primary diagnosis of OCD.

Family Cognitive-Behavioral Treatment for a Child With Autism and Comorbid Obsessive Compulsive Disorder

Cognitive-behavioral therapy (CBT) with exposure/response prevention is effective among youth with autism spectrum disorders (ASDs) and comorbid anxiety symptoms. This case illustrates the application of a modularized family-based CBT approach with a school-aged boy with autistic disorder and comorbid obsessive-compulsive disorder (OCD). Following 16 family sessions over 21 weeks, “Jerry,” a 9-year-old Caucasian male, showed significant reduction in obsessive-compulsive symptoms. Jerry’s parents also reported improvements in emotional regulation, participation in school activities, and in his parent–child relationships. This case study illustrates the use of family-based CBT, which has been modified to account for social and behavioral deficits endemic to ASDs, for school-aged youth with autism and comorbid OCD.

Sudden Gains in the Treatment of Obsessive-Compulsive Disorder

Background: The present study examined sudden gains during treatment for obsessive-compulsive disorder (OCD) and their relationship to short- and long-term outcome. Methods: Ninety-one individuals (age 19–64) completed either cognitive treatment, exposure treatment, or their combination with fluvoxamine for OCD. Participants’ obsessive-compulsive symptoms were assessed before each weekly treatment session. In addition, obsessive-compulsive and depressive symptoms were assessed pre treatment and post treatment as well as 12 months following treatment termination. Results: Sudden gains were found among 34.1% of participants and constituted 65.5% of the total reduction in obsessive-compulsive symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of OCD symptoms post treatment, and this was maintained during follow-up. Conclusions: Sudden gains are common in treatments for OCD and are predictive of treatment outcome and follow-up. Sudden gains mark a distinct trajectory of response to treatment for OCD. Individuals with sudden gains greatly improve during treatment and maintain their gains during follow-up, whereas individuals without sudden gains improve to a significantly lesser extent. Thus, treatment planning and development can benefit from considering sudden gains and the intra-individual course of improvement.

Dysfunctional beliefs in the process of change of cognitive treatment in obsessive compulsive checkers

Cognitive behaviour therapy (CBT) is considered to be effective in the reduction of obsessive compulsive symptoms. However, questions remain as to how CBT works. Cognitive-behavioural models postulate that negative appraisals of intrusive thoughts and dysfunctional beliefs that give rise to them underlie the development and maintenance of obsessive-compulsive disorder (OCD). The current study aimed to study this hypothesis by investigating the processes of change over the course of cognitive treatment for OCD. Furthermore, a new theoretical approach and method for studying processes of change was presented. The participants were seven patients suffering from OCD with predominantly checking symptoms. Process variables (beliefs, anxiety and compulsions) were measured using idiosyncratic diaries and were analysed on an intra- and inter-individual level using dynamic systems methods. Results showed significant decreases in credibility of dysfunctional beliefs in six out of the seven participants, which is in line with the cognitive-behavioural model. Associations between process variables were in general medium to high. However, the actual patterns of change showed important intra- and interpersonal differences. Results indicated that different paths can lead to clinical recovery, and it was concluded that process studies that focus on individual trajectories of change can contribute to our understanding of OCD and its treatment. Furthermore, dynamic systems methods provide insight into intra-individual processes and shed a new light on variability.

Treatment of Obsessive Compulsive Disorder in Young Children: An Intervention Model and Case Series

This article presents an intervention model for young children with obsessive-compulsive disorder (OCD). The intervention, designed to reduce compulsive behavior and improve parenting practices, was tested using a multiple baseline design with 7 children (M = 6 years old; 57% female) in which participants were randomly assigned to 1, 2, or 3 weeks of baseline (i.e., no treatment). All children were diagnosed with OCD using a semi-structured diagnostic interview. Baseline and weekly ratings of obsessive-compulsive (OC) symptoms and family accommodation were obtained. In addition, at pre- and post-treatment and 1-month follow-up, independent evaluators and/or parents completed measures assessing the severity and impact of OC symptoms and child and family functioning. Findings revealed that participants had a 33–66% reduction in OC symptoms (as measured by the Children's Yale-Brown Obsessive Compulsive Scale; CYBOCS) at posttreatment and 6 of the 7 children were rated as treatment responders on the Clinical Global Impression-Improvement (CGI-I) Scale. At the 1-month follow-up, participants had a 17–82% reduction in OC symptoms. Treatment was also effective in reducing parental accommodation of child OC behaviors. Overall treatment satisfaction was high and parents found most core treatment ingredients (e.g., psychoeducation, exposure and ritual prevention, contingency management) very helpful. Implications for further developing and testing psychosocial treatments for young children are discussed.

P01-147 - Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder

ObjectiveWe report the case of a patient with treatment-resistant obsessive-compulsive disorder (OCD) that had a significant reduction in obsessive-compulsive symptoms after the addition of the atypical antipsychotic to the Selective serotonin reuptake inhibitors (SSRIs)MethodsMs. A, a 31-year-old woman, with no family history of psychiatric disorders has been suffering from OCD for 4 years. His main obsession was contamination, and his compulsions (washing rituals) occupied 12 hours a day, rendering him unfit for work in there house or employment. Various treatments had been ineffective. His Yale-Brown Obsessive Compulsive Scale total score (Y-BOCS) at his first psychiatric interview was 38. He was taking clomipramine, sertraline, haloperidol, amisulpride, and alprazolam. Previous trials did not result in clinically meaningful responses (side effects prevented titration to higher doses), however all psychiatric drugs were discontinued except sertraline (100 mg/day) associated with olanzapine (5 mg/day).ResultAfter 10 days, Ms. A reported significantly lessened anxiety and, after three months, significantly lessened obsessive-compulsive symptoms. By the fourth month, his symptoms were occurring for only few hours week (Y-BOCS total score of 16). At this point, the addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients.ConclusionCurrent options for treatment-resistant OCD include switching to an alternative selective serotonin reuptake inhibitor or augmentation with other agents. Our case suggests that olanzapine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation.

P01-126 - Olanzapine augmentation for treatment-resistant obsessive-compulsive disorder: a case report

ObjectiveWe report the case of a patient with treatment-resistant obsessive-compulsive disorder (OCD) that had a significant reduction in obsessive-compulsive symptoms after the addition of the atypical antipsychotic to the Selective serotonin reuptake inhibitors (SSRIs)MethodsMs. A, a 31-year-old woman, with no family history of psychiatric disorders has been suffering from OCD for 4 years. His main obsession was contamination, and his compulsions (washing rituals) occupied 12 hours a day, rendering him unfit for work in there house or employment. Various treatments had been ineffective. His Yale-Brown Obsessive Compulsive Scale total score (Y-BOCS) at his first psychiatric interview was 38. He was taking clomipramine, sertraline, haloperidol, amisulpride, and alprazolam. Previous trials did not result in clinically meaningful responses (side effects prevented titration to higher doses), however all psychiatric drugs were discontinued except sertraline (100 mg/day) associated with olanzapine (5 mg/day).ResultAfter 10 days, Ms. A reported significantly lessened anxiety and, after three months, significantly lessened obsessive-compulsive symptoms. By the fourth month, his symptoms were occurring for only few hours week Y-BOCS total score of 16). At this point, the addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients.ConclusionCurrent options for treatment-resistant OCD include switching to an alternative selective serotonin reuptake inhibitor or augmentation with other agents. Our case suggests that olanzapine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation.

Risperidone augmentation in refractory obsessive compulsive disorder: An open-label study

Risperidone, an atypical neuroleptic, has been proposed for augmentation strategies in resistant obsessive-compulsive disorder (OCD). We report the results of an open-label trial on the use of the combination of serotonin reuptake inhibitors (SRIs) with risperidone in 20 refractory OCD outpatients. All patients had been suffering from OCD, according to DSM-IV criteria, for at least 2 years and had various comorbid disorders. All had been treated with a SRI at adequate dosages for at least 6 months, but had failed to respond. Therefore, risperidone was added and the dosage titrated up to the mean dose of 3 mg/day over 8 weeks. After 2 months of this regimen, all patients had shown a reduction in obsessive-compulsive symptoms, as assessed by the decrease in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score, particularly those with a lifetime comorbidity with bipolar disorder; only three patients reported mild sedation and postural hypotension, two mild extrapyramidal side-effects (tremors and akatysia) and two an increased appetite. All these effects were well tolerated and no patient halted the treatment. The addition of risperidone would appear to be a useful strategy for augmenting SRI effectiveness in refractory OCD patients.

A Controlled Trial of Lithium Augmentation in Fluvoxamine-Refractory Obsessive-Compulsive Disorder

Two- and 4-week double-blind placebo-controlled trials of lithium augmentation of ongoing fluvoxamine treatment trials were conducted in 20 and 10 patients, respectively, with primary obsessive-compulsive disorder (OCD) who had failed to respond to fluvoxamine alone. Although 2 weeks of double-blind lithium augmentation produced a small but statistically significant reduction in obsessive-compulsive symptoms, most patients did not have a clinically meaningful response. Furthermore, there was no statistical or clinical improvement in obsessive-compulsive symptoms during the subsequent 4-week double-blind, placebo-controlled trial of lithium augmentation. On the basis of treatment response criteria, only 18% and 0% of the patients responded to lithium augmentation of fluvoxamine during the 2- and 4-week treatment trials, respectively. In light of the previously reported 44% response rate to lithium augmentation in treatment-resistant depressed patients on fluvoxamine, the results of this study suggest that pathophysiological differences may exist between OCD and depression. The routine use of lithium augmentation in the management of patients with OCD who are refractory to serotonin reuptake inhibitors is not supported by these findings.