Optimal treatment for obsessive compulsive disorder: a randomized controlled feasibility study of the clinical-effectiveness and cost-effectiveness of cognitive-behavioural therapy, selective serotonin reuptake inhibitors and their combination in the management of obsessive compulsive disorder

Established treatments for obsessive compulsive disorder (OCD) include cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication. Combined treatment may outperform monotherapy, but few studies have investigated this. A total of 49 community-based adults with OCD were randomly assigned to CBT, SSRI, or SSRI+CBT. Sertraline (50–200 mg/day) was given as the SSRI for 52 weeks. A 16-h-manualized individual CBT was delivered over 8 weeks with four follow-up sessions. Assessors were ‘blinded’ to treatment allocation. A preliminary health economic evaluation was conducted. At week 16, combined treatment (n=13) was associated with the largest improvement, sertraline (n=7) the next largest and CBT (n=9) the smallest on the observed case analysis. The effect size (Cohen’s d) comparing the improvement in Yale Brown Obsessive Compulsive Scale on CBT versus combined treatment was −0.39 and versus sertraline was −0.27. Between 16 and 52 weeks, the greatest clinical improvement was seen with sertraline, but participant discontinuation prevented reliable analysis. Compared with sertraline, the mean costs were higher for CBT and for combined treatment. The mean Quality Adjusted Life Year scores for sertraline were 0.1823 (95% confidence interval: 0.0447–0.3199) greater than for CBT and 0.1135 (95% confidence interval: -0.0290–0.2560), greater than for combined treatment. Combined treatment appeared the ...
Source: International Clinical Psychopharmacology - Category: Psychiatry Tags: Original Articles Source Type: research

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Publication date: Available online 28 August 2019Source: Journal of Anxiety DisordersAuthor(s): Tamara Leeuwerik, Kate Cavanagh, Clara StraussAbstractWhilst Cognitive Behavioural Therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherenc...
Source: Journal of Anxiety Disorders - Category: Psychiatry Source Type: research
CONCLUSION: There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. PROSPERO: CRD420180961655-6. PMID: 31339342 [PubMed - as supplied by publisher]
Source: The Australian and New Zealand Journal of Psychiatry - Category: Psychiatry Authors: Tags: Aust N Z J Psychiatry Source Type: research
ConclusionReassurance seeking appears to be a common factor across anxiety disorders though the themes of the reassurance may differ. Further, reduction in excessive reassurance seeking may be an important component in treatment outcome.
Source: Journal of Anxiety Disorders - Category: Psychiatry Source Type: research
This article describes the use of a case formulation approach, integrating evidence-based treatment in the context of individual clinical traits. It focuses on the supplementation of cognitive behavioural therapy (CBT) with eye movement desensitization and reprocessing (EMDR) in the treatment of a young person, presenting with an initial diagnosis of obsessive-compulsive disorder (OCD). A case formulation suggested the possibility of a differential diagnosis of Adjustment Disorder, indicating the usefulness of the addition of EMDR sessions to process memories of severe bullying. Previous studies promote the idea of using E...
Source: Journal of Child and Adolescent Trauma - Category: Child Development Source Type: research
ConclusionsGuided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.
Source: Journal of Behavior Therapy and Experimental Psychiatry - Category: Psychiatry Source Type: research
AbstractDigital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for...
Source: Psychiatric Quarterly - Category: Psychiatry Source Type: research
Another version of this new video-based smartphone intervention involved participants watching their own earlier hand washing By Emma Young Almost half of people with Obsessive Compulsive Disorder (OCD) have extreme fears about touching something they feel is “contaminated”. This can mean that after touching a doorknob, say, they then feel compelled to scrub their hands, in some cases even until they bleed. Conventional treatments, which often involve a combination of a prescription drug (typically an “SSRI”, such as Prozac) plus cognitive behavioural therapy (CBT), help only about 60 per cent of pe...
Source: BPS RESEARCH DIGEST - Category: Psychiatry & Psychology Authors: Tags: Mental health Source Type: blogs
This study provides a preliminary exploration of factors which differentially predict treatment response to telephone-delivered cognitive behavioural therapy (TCBT) compared to face-to-face CBT (CBT) in a randomised non-inferiority controlled trial of 72 children (aged 11-18 years) with obsessive-compulsive disorder (OCD). Potential moderator variables, their interaction with treatment group (CBT, TCBT) and baseline levels of OCD severity were entered into separate regression models where the primary outcome measure was the post-intervention Children's Yale-Brown Obsessive-Compulsive Scale total score (CYBOCS). Separa...
Source: Cognitive Behaviour Therapy - Category: Psychiatry & Psychology Authors: Tags: Cogn Behav Ther Source Type: research
Conditions:   Obsessive-Compulsive Disorder in Children;   Obsessive-Compulsive Disorder in Adolescence Interventions:   Behavioral: Family Based Cognitive Behavioural Therapy;   Behavioral: Family Based Psychoeducation/Relaxation Training Sponsors:   Anne Katrine Pagsberg;   Danish Research Centre for Magnetic Resonance;   Copenhagen Trial Unit, Center for Clinical Intervention Research Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Karen Morley blogs about her experience of seeking help for her Obsessive-Compulsive Disorder (OCD) and how finding and using Cochrane evidence was a turning point. This blog post was originally published onEvidently Cochrane.Without knowing what it was, I had experienced episodes of Obsessive-Compulsive Disorder (OCD) since I was an adolescent, usually when I was particularly stressed. But it was when I was caring full time for my mother, who had multiple conditions including dementia, that I had an unusually distressing episode of contamination-related OCD. When I took to the internet I was amazed to discover that the ob...
Source: Cochrane News and Events - Category: Information Technology Authors: Source Type: news
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