Therapy For Obsessive-compulsive Disorder Research Articles

Increased Amygdala Activation during Symptom Provocation Predicts Response to Combined Repetitive Transcranial Magnetic Stimulation and Exposure Therapy in Obsessive-Compulsive Disorder in a Randomized Controlled Trial.

Repetitive transcranial magnetic stimulation (rTMS), combined with exposure and response prevention (ERP), is a promising treatment modality for treatment-refractory obsessive-compulsive disorder (OCD). Yet, not all patients respond sufficiently to this treatment. We investigated whether brain activation during a symptom provocation task could predict treatment response. Sixty-one adults with OCD (22 male/ 39 female) underwent symptom provocation with OCD- and fear-related visual stimuli during fMRI prior to an 8-week combined rTMS and ERP treatment regimen. Participants received one of the three following rTMS treatments as part of a randomized controlled trial: (1) 10Hz rTMS (110% resting motor threshold (RMT)) to the left dorsolateral prefrontal cortex (DLPFC); (2) 10Hz rTMS (110% RMT) to the left pre-supplementary motor area (preSMA); or (3) 10Hz control rTMS (60% RMT) to the vertex. Multiple regression and correlation were used to examine the predictive value of task-related brain activation for treatment response in the following ROIs: dorsomedial prefrontal cortex, amygdala, DLPFC, and preSMA. The different treatment groups responded equally to treatment. Higher pre-treatment task-related activation of the right amygdala to OCD-related stimuli showed a positive association with treatment response in all groups. Exploratory whole-brain analyses showed positive associations between activation in multiple task-relevant regions and treatment response. Only dorsal anterior cingulate cortex activation to fear-related stimuli showed a negative association with treatment outcome. Higher pre-treatment right amygdala activation during symptom provocation predicts better treatment response to combined rTMS and ERP in OCD.

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

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

Effectiveness of Integrated Model of Psychological Intervention and Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: A Comparative Study

Background. Current study aims to explore the effectiveness of the integrated model of psychological intervention in comparison to psychotherapy and pharmacotherapy to reduce the severity of symptoms of Obsessive Compulsive Disorder in individuals experiencing it. Findings suggested that integrated model is an efficacious and effective treatment modality with CBT and pharmacotherapy being effective but time taking. The integrated model of psychological intervention emphasizes the therapeutic alliance and is brief and time limited approach as compared to other treatment modalities. Method. 24 participants aged, 20-35, included in the study filled measurement scale, the Yale- Brown Obsessive Compulsive Scale (Y-BOCS). Results. The study results showed noticeable indication that integrated model is useful and effectual for the treatment of psychological symptoms among patients of OCD. Conclusions. Further comparative studies could be done in future years comparing the efficacy of the proposed model with other therapeutic approaches in absence of pharmacological treatment.

325. Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined rTMS and Exposure Therapy in Obsessive-Compulsive Disorder

325. Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined rTMS and Exposure Therapy in Obsessive-Compulsive Disorder

Resting-state functional connectivity of amygdala subregions predicts treatment outcome for cognitive behavioral therapy in obsessive-compulsive disorder at a 4-month follow-up

BackgroundCognitive behavioral therapy (CBT) is considered as the first-line treatment for obsessive-compulsive disorder (OCD). However, the underlying neural mechanisms through which CBT exerts its effects in OCD remain unclear. This study aims to investigate whether the improvement of clinical symptoms in OCD patients after CBT treatment is associated with changes in resting-state functional connectivity (FC) of the amygdala subregion, and whether these changes can be served as potential predictors of four-months treatment efficacy. MethodsWe collected resting-state functional magnetic resonance imaging (rs-fMRI) data from 57 OCD patients and 50 healthy subjects at baseline. In the patient group, rs-fMRI was also obtained after completion of an 8-week CBT treatment and 4 months post-treatment. A whole-brain rsFC analysis was conducted using the amygdala subregion as the seed point. We analyzed the FC patterns in relation to 4 months clinical outcomes to elucidate the long-term efficacy of CBT in OCD patients. ResultsTreatment responseat at pre-treatment was found to be associated with reduced rsFC between the left basolateral amygdala(BLA)and left superior temporal gyrus(STG) at baseline. Lower pre-treatment FC were negatively correlated with the severity of OCD symptoms as measured by the Yale-Brown Obsessive Compulsive Severity Scale (Y-BOCS). Moreover, the area under the receiver operating characteristic (ROC) curve for the FC between the left BLA and STG at the end of treatment was 73.0% and 70.4% for the effective-ineffective and remitted or unremitted groups, respectively. At the 4-month follow-up, the area under the ROC curve for the effective-ineffective and remitted or unremitted groups was 83.9% and 76.5%, respectively. ConclusionThese findings suggest that brain functional activity in patients with OCD can predict treatment response to CBT, and longitudinal changes in relevant brain functional activity following CBT treatment are associated with treatment response in OCD.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Brief Review

Treatment for obsessive-compulsive disorder (OCD) has drastically improved since behavioral models emerged over 60 years ago. Exposure and response prevention (ERP), the “gold standard” psychotherapy for OCD, is highly efficacious, yet a significant portion of patients either cannot access it or continue to experience residual symptoms following treatment. A growing body of research suggests other cognitive-behavioral approaches, particularly cognitive therapy, demonstrate comparable treatment effects to ERP. This brief review outlines research-supported cognitive-behavioral therapies for OCD including behavioral, cognitive, and “third wave” approaches such as metacognitive therapy and acceptance and commitment therapy. The theoretical foundations as well as an overview of research findings for each therapy are summarized. Recommendations for improving outcomes and access to treatment are also provided. [ Psychiatr Ann . 2024;54(3):e75–e79.]

Therapy of obsessive-compulsive disorder: psychology and religion

This article is an integral part of a series of publications in which, based on specific cases of child-parent relations, the positive dynamics of psychological work on the basis of Ingush culture and religious values is shown. It describes the culture of providing psychological assistance, taking into account the spiritual heritage of the client and the whole paper refers to a specific case as the example.The article includes a brief description of obsessive-compulsive disorder, diagnostic criteria, the course of the disease, its epidemiology. OCD is considered from the standpoint of various theories. The process of short-term therapy is described in detail. The strength of the work is the presence of a step-by-step description of the techniques used.The results of the experience accumulated by the author show that the multicultural competence of the therapist provides him not only a high level of trust from the client, but also a professional approach based on the use of ethno-religious resources in therapeutic work.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness.

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

Do all obsessions contradict personal values to the same degree? A pilot investigation.

Although much is known about how intrusive thoughts become obsessions, the factors that determine which particular thoughts do so is not. The degree to which intrusions are personally significant may be such a determinant. Obsessive-compulsive disorder (OCD) is heterogeneous; thus, it is possible that contradictions of personal values may play a varying role in the development of obsessions depending on which OCD symptoms manifest and may change differentially following treatment. Archival data were examined. Patients with a diagnosis of OCD (N = 62) reported their most upsetting obsession and the degree to which it violated values both pre- and postparticipation in group cognitive-behavioral therapy for OCD. At pretreatment, contradiction ratings differed across symptom domains, such that participants with primary symptoms of obsessions/checking exhibited contradiction ratings that were significantly greater than did participants with other primary symptoms. Contradiction ratings did not change posttreatment. Implications for the conceptualization of OCD are discussed.

Home-Based Individualized Alpha Transcranial Alternating Current Stimulation Improves Symptoms of Obsessive-Compulsive Disorder: Preliminary Evidence from a Randomized, Sham-Controlled Clinical Trial

Obsessive-compulsive disorder (OCD) is a debilitating mental health condition that is largely resistant to conventional treatments, such as pharmacotherapy and behavioural interventions. Individualized noninvasive brain stimulation techniques such as transcranial alternating current stimulation (tACS) might be capable of successfully treating OCD through modulation of dysfunctional neural circuitry. A randomized, double-blind, sham-controlled, pilot clinical trial involving 25 OCD patients was conducted to investigate the efficacy of tACS in improving OCD severity. Treatments targeting the medial prefrontal cortex (mPFC) were self-administered at home for 6 weeks with a 3-month follow-up. Within the active group, each treatment was delivered at an individualized peak alpha frequency for 30 minutes, while the sham group received 2 blocks of 2-minute treatments at 25 Hz. The clinical severity of OCD and potential symptom improvements were quantified using serial measurements of the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and a linear mixed model analysis was performed to estimate the time-condition effect. There was a significant time-condition interaction in the YBOCS from baseline to 6 weeks ( p < 0.0001 ), indicating that active alpha-tACS was significantly superior to sham in improving OCD severity. A trend-level effect remained at the 3-month follow-up, suggestive of a sustained level of improvement. Additionally, depressive symptoms also showed a significant improvement from baseline to follow-up. Our findings suggest that a six-week, home-based treatment course of individualized alpha-tACS targeting the mPFC is capable of improving OCD symptoms. Further large-scale clinical trials are required to definitively establish tACS as a therapy for OCD.

Acute administration of the NMDA receptor antagonists ketamine and MK-801 reveals dysregulation of glutamatergic signalling and sensorimotor gating in the Sapap3 knockout mouse model of compulsive-like behaviour

Obsessive-compulsive disorder (OCD) is characterised by excessive intrusive thoughts that may cause an individual to engage in compulsive behaviours. Frontline pharmacological treatments (i.e., selective serotonin reuptake inhibitors (SSRIs)) leave approximately 40% of patients refractory to treatment. To investigate the possibility of novel pharmacological therapies for OCD, as well as the potential mechanisms underlying its pathology, we used the Sapap3 knockout (KO) mouse model of OCD, which exhibits increased anxiety and compulsive grooming behaviours. Firstly, we investigated whether administration of the NMDA receptor (NMDAR) antagonist ketamine (30 mg/kg), would reduce anxiety and grooming behaviour in Sapap3 KO mice. Anxiety-like behaviour was measured via time spent in the light component of the light-dark box test. Grooming behaviour was recorded and scored in freely moving mice. In line with previous works conducted in older animals (i.e. typically between 6 and 9 months of age), we confirmed here that Sapap3 KO mice exhibit an anxious, compulsive grooming, hypolocomotive and reduced body weight phenotype even at a younger age (i.e., 2-3 months of age). However, we found that acute administration of ketamine did not cause a reduction in anxiety or grooming behaviour. We then investigated in vivo glutamatergic function via the administration of a different NMDAR antagonist, MK-801 (0.25 mg/kg), prior to locomotion and prepulse inhibition assays. We found evidence of altered functional NMDAR activity, as well as sexually dimorphic prepulse inhibition, a measure of sensorimotor gating, in Sapap3 KO mice. These results are suggestive of in vivo glutamatergic dysfunction and their functional consequences, enabling future research to further investigate novel treatments for OCD.

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

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

Patient feedback and psychosocial outcomes of deep brain stimulation in people with obsessive–compulsive disorder

Severe and refractory psychiatric patients can experience complex and profound changes in symptomology, functioning and well-being from deep brain stimulation (DBS) therapy. Currently, the efficacy of DBS is assessed by clinician rated scales of primary symptoms, yet this does not capture the multitude of DBS mediated changes or represent the patient perspective. We aimed to elucidate the patient perspective in psychiatric DBS application by investigating 1) symptomatic, and 2) psychosocial changes, 3) therapeutic expectations and satisfaction, 4) decision-making capacity, and 5) clinical care recommendations from treatment refractory obsessive–compulsive disorder (OCD) DBS patients. Participants enrolled in an open label clinical trial of DBS therapy for OCD who had reached clinical response were invited to participate in a follow up survey. Participants completed a 1) feedback survey relating to goals, expectations, and satisfaction of therapy, and 2) self-report questionnaires on psychosocial functioning including quality of life, cognitive insight, locus of control, rumination, cognitive flexibility, impulsivity, affect, and well-being. Greatest change was reported for quality of life, rumination, affect and cognitive flexibility. Participants reported realistic expectations, high satisfaction, adequate pre-operative education and decision-making capacity; and advocated for greater access to DBS care and more widespread support services. This is the first identified investigation on psychiatric patient perspectives of functioning and therapeutic outcomes following DBS. Insights from the study have implications for informing psychoeducation, clinical practices, and neuroethical debates. We encourage a greater patient-centred and biopsychosocial approach in evaluating and managing OCD DBS patients, by considering personally meaningful goals and addressing symptomatic and psychosocial recovery.

Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients.

Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.

Sertraline on Obsessive Compulsive Disorders in Indonesia (A Case Study)

Background: Obsessive-compulsive disorder (OCD) was originally believed to be a rare mental illness. However, recent surveys and research have shown that OCD is one of the most common mental disorders. Research in India showed that the treatment of OCD using SSRIs (selective serotonin reuptake inhibitors) is preferred over the tricyclic group. This paper will discuss sertraline as the alternative to clomipramine for OCD. Objective: Clomipramine as the treatment of choice for OCD is no longer included in the Indonesian MIMS index. Recent research suggests sertraline is preferred over clomipramine, and this paper discusses the efficacy of sertraline through a case study. Methods: This study is a retrospective descriptive study on the case of 21-year-old male met the ICD-X criteria of OCD for having unwanted thoughts and repetitive behavior for locking the door and orderly compiling the books. The symptoms developed since he graduated from high school (three years before admission) and got worse since the last year. Sertraline was prescribed in the first place. The patient was routinely monitored during each visit for the next three months. Results: The symptoms improved significantly after routinely taking sertraline for two months. The adverse effects were well-tolerated, such as nausea, headaches, and tachycardia. Psychotherapy was needed to modify the patient’s obsession and to anticipate the risk of personality disorder should be noticed because the disorder appeared at a young age. Conclusion: Sertraline as well as psychotherapy are worthy of consideration as first-line OCD therapy in Indonesia.

Quand aider devient nuire : une compréhension des implications de l’accommodation familiale sur l’efficacité des interventions psychologiques dans le TOC

The objective of this article is to present a review of current knowledge of the consequences and determinants of family accommodation in adults, children and adolescents. Family accommodation can be defined as the changes in behavior adopted by family members of a relative suffering from a mental disorder in order to reduce the associated suffering and distress (e.g., participating in OCD rituals or helping with avoidance). This phenomenon is particularly frequent since it is observed in from 70 to 97% of the relatives interviewed in the studies, whether the patients are adults or children. To present this mechanism, this article will discuss the underlying theoretical models in obsessive-compulsive disorder (OCD) as well as outline the epidemiology, consequences and maintaining factors of family accommodation. The second part of this article will deal with the principal programs and methods of treatment of family accommodation. To this end, a review of the literature regarding family accommodation was conducted using the following databases: PubMed, Google Scholar, ScienceDirect, and PsycINFO, without date limitation. Sixty-seven articles were selected to explore the question of family accommodation in OCD, both in child and adult populations. The data in the literature clearly show that family accommodation is an important factor in the perpetuation of OCD and anxiety symptomatology. Indeed, this accommodation would seem to impede attempts to learn new functional behavior by not allowing the person to perceive the negative consequences of his or her symptomatic behavior or by preventing him or her from experiencing habituation to anxiety-provoking stimuli. In addition, several studies have shown a moderate correlation between the intensity of OCD and family accommodation, as well as the negative effects on the quality of the relationship in couples, or an increase in the perceived burden for the relative. Another finding that seems relevant to clinical practice is that family accommodation is negatively associated with the effectiveness of psychotherapeutic interventions. Indeed, it has been shown that a high level of family accommodation is positively correlated with a low response to psychotherapeutic and pharmacological treatments. Family accommodation has been shown to be a factor in the failure of psychotherapies by distorting the learning achieved in therapy, as well as by leading to greater functional deterioration in the patient. This accommodation is also a predictor of non-spontaneous recovery. These data, therefore, indicate the importance of considering this mechanism in the treatment of patients suffering from OCD, regardless of their age or sex. In the second part of the article, we discuss many proposals for interventions, based on CBT models, which have emerged in recent years in order to maximize the effectiveness of therapies for OCD and anxiety disorders. Their aim is to integrate the family member into the therapy so that he or she can understand the interest in changing his or her reinforcing behavior. In addition to understanding the importance of change, they can be helped by the therapist. Most of these programs are for children only, but some do exist for relatives of adult patients. These propositions for the treatment of family accommodation seem to demonstrate interesting evidence in favor of their effectiveness. However, considering the small number of existing programs, and the small sample sizes that have led to their validation, further research is needed on this topic in order to highlight key interventions that can lead to a decrease in family accommodation. In conclusion, despite an acceleration of research during the last decade, family accommodation remains relatively insufficiently studied, particularly in adults. Recently, family accommodation has been demonstrated in cases of depression, all anxiety disorders, autism spectrum disorders, eating disorders and in chronic pain. There is still a lack of evidence for the existence of this process in certain disorders such as schizophrenia or bipolarity, but it is easy to hypothesize that a change in behavior can be found in the relatives of people suffering from these types of pathologies. In consideration of these results and of the negative impact of family accommodation on the treatment of mental pathologies, a better understanding of family accommodation and its consideration in all psychiatric pathologies seems essential in the future in order to increase the effectiveness of treatment proposals.

Predicting responses to cognitive behavioral therapy in obsessive-compulsive disorder based on multilevel indices of rs-fMRI

ObjectiveThis study aimed to identify neuroimaging predictors to predict the response of cognitive behavioral therapy (CBT) in patients with obsessive-compulsive disorder (OCD) based on indices of resting-state functional magnetic resonance imaging (rs-fMRI). MethodsFifty patients with OCD were enrolled and allocated to either high or low responder groups after CBT using a 50 % response rate as the delineator. The pre-treatment amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and degree centrality (DC) in each cerebrum region, defined by automated anatomical labeling atlas, were extracted. Least absolute shrinkage and selection operator and logistic regression were used to select features and establish models. ResultsThe combination of multilevel rs-fMRI indices achieved the best performance, with a cross-validation area under the receiver operating characteristic curve (AUC) of 0.900. In this combined model, an increase of interquartile range (IQR) in fALFF of right inferior orbital frontal gyrus (IOFG), and ReHo of left hippocampus and superior occipital gyrus (SOG) corresponded to a 26.52 %, 38.67 % and 24.38 % increase in the possibility to be high responders of CBT, respectively. ALFF of left thalamus and ReHo of left putamen were negatively associated with the response to CBT, with a 14.30 % and 19.91 % decrease per IQR increase of the index value. ConclusionThe combination of ALFF, fALFF and ReHo achieved a better predictive performance than separate index. Pre-treatment ALFF of the left thalamus, fALFF of the right IOFG, ReHo of the left hippocampus, SOG and putamen can be used as predictors of CBT response.

Efficacy and fMRI-based response predictors to mindfulness-based cognitive therapy in obsessive-compulsive disorder: Study protocol for a randomised clinical trial.

Around 40-50% of patients with obsessive-compulsive disorder (OCD) suffer from obsessions and compulsions after receiving first-line treatments. Mindfulness-based cognitive therapy (MBCT) has been proposed as a reasonable augmentation strategy for OCD. MBCT trains to decentre from distressful thoughts and emotions by focusing on them voluntarily and with consciousness. This practice develops alternative ways to deal with obsessions, which could increase non-reactivity behaviours and, in turn, reduce compulsions. This study aims to investigate the efficacy of MBCT to improve OCD symptoms. Secondly, it pursues to investigate which socio-demographic, clinical, and neurobiological characteristics mediate or moderate the MBCT response; and identify potential biomarkers of positive/negative response. This study is a randomised clinical trial (RCT) of 60 OCD patients who do not respond to first-line treatments. Participants will be randomised to either an MBCT program or treatment as usual. The MBCT group will undergo 10 weekly sessions of 120min. Principal outcome: change in OCD severity symptoms using clinician and self-reported measures. Also, participants will undergo a comprehensive evaluation assessing comorbid clinical variables, neuropsychological functioning and thought content. Finally, a comprehensive neuroimaging protocol using structural and functional magnetic resonance imaging will be acquired in a 3T scanner. All data will be obtained at baseline and post-intervention. This study will assess the efficacy of mindfulness in OCD patients who do not achieve clinical recovery after usual treatment. It is the first RCT in this subject examining clinical, neuropsychological and neuroimaging variables to examine the neural patterns associated with the MBCT response. NCT03128749.

A thematic analysis of barriers and facilitators to participant engagement in group exposure and response prevention therapy for obsessive-compulsive disorder.

Exposure and response prevention (ERP) is the gold standard in the treatment of the obsessive-compulsive disorder (OCD). It can be delivered effectively using an individual or group therapy format. Nonetheless, a sizeable proportion of people diagnosed with OCD do not experience OCD symptom remission following ERP. Research suggests that participant engagement with ERP tasks predicts therapy outcomes but there is little consistent evidence across studies on what predicts engagement. A recent meta-analysis of participant engagement in cognitive-behavioral therapy for OCD found that group ERP had a comparatively lower dropout rate than individual ERP. Little is known about participant perceptions of ERP to guide an understanding of how the group therapy format may affect participant engagement. This study conducted a qualitative exploration of what helps or hinders participants' engagement in group ERP. It involved thematic analysis of semi-structured interview data collected at a 6-month follow-up from 15 adults with OCD who took part in group ERP. The study identified five main themes that captured participants' perceived facilitators and barriers to engagement in therapy: 'Group processes', 'Understanding how to overcome OCD', 'Personal relevance', 'Personal circumstances', and 'Attitudes towards ERP', which captured dynamically inter-related barriers and facilitators at the level of the client, therapist, therapy and social environment. Each theme and associated sub-themes are discussed in turn, followed by a consideration of the study's limitations and implications.

Clinical Evidence for the Effectiveness of Herbal Medicines in the Treatment of an Obsessive- Compulsive Disorder: A Review Study.

Obsessive-compulsive disorder (OCD) is a potentially debilitating disease that affects 1-4% of the general population. It is characterized by the presence of obsessions and compulsions which interfere with the individual's life and functioning. Although conventional treatments such as drug therapies and cognitive behavioral therapy exist for OCD, these treatments are not universally successful and can cause side effects, which has created a demand for alternative and complementary therapies. In this review, we summarize randomized clinical trials on the effectiveness of herbal medicines for the treatment of OCD, and review the possible mechanisms of action for these medicines. A search in PubMed, Scopus, and The Cochrane Library found 1022 studies, of which 7 were included in our review. The studies that we found were conducted over 6 to 12 weeks, and had an average sample size of 37. The plant species studied included Crocus sativus, Echium amoenum, Hypericum perforatum, Silybum marianum, Valeriana officinalis, and Withania somnifera. The trials demonstrated the effectiveness of all plants as treatments for OCD except H. perforatum. The phytochemicals found in these plants produce their effects through a variety of means such as inhibiting the reuptake of monoamines, GABAergic effects, and neuroendocrine modulation. The small number of studies and their small sample sizes, poor methodology, and lack of replication highlight the need for further research into herbal medicines for the treatment of OCD. Overall, herbal medicines can be used as stand-alone therapies for OCD or in conjunction with other methods.