Mindfulness-based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial.

Up to one-third of individuals with obsessive-compulsive disorder (OCD) do not benefit from evidence-based psychotherapy. We examined the efficacy of mindfulness-based cognitive therapy (MBCT) as a complementary treatment option. In a prospective, bicentric, assessor-blinded, randomized, and actively controlled clinical trial, 125 patients with OCD and residual symptoms after cognitive behavioral therapy (CBT) were randomized to either an MBCT group (n = 61) or to a psychoeducational group (OCD-EP; n = 64) as an active control condition. At post-treatment, there was no significant benefit of MBCT over OCD-EP with the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) as the primary outcome measure, but with the Obsessive-Compulsive Inventory [OCI-R; F(1, 101) = 5.679, p = .036, effect size η2partial = 0.053]. Moreover, the response rate and the improvement on secondary outcomes such as obsessive beliefs and quality of life was significantly larger in the MBCT group. Non-completion rates were below 10%. At the 6-month follow-up, OC symptoms were further improved in both groups; group differences were no longer significant. Our findings suggest that MBCT, compared to a psychoeducational program, leads to accelerated improvement of self-reported OC symptoms and secondary outcomes, but not of clinician-rated OC symptoms. In the midterm, both interventions yield similar and stable, but small improvements, suggesting that additional treatment options may be necessary.

Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges. METHODS/DESIGN: This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task. DISCUSSION: The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD. TRIAL REGISTRATION: German Clinical Trials Register DRKS00004525 . Registered 19 March 2013.

Direct and indirect assessment of perfectionism in patients with depression and obsessive-compulsive disorder.

According to the transdiagnostic perspective, psychological disorders share common cognitive processes involved in their pathogenesis. One dysfunctional belief that has been found to be associated with several psychological disorders, including major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), is perfectionism. Perfectionism comprises two factors, namely, perfectionistic strivings and perfectionistic concerns. This study aims to replicate and extend previous research in several ways. We aimed to assess similarities between the two disorders using Bayesian statistics. Furthermore, as dysfunctional beliefs are assumed to not be fully accessible by introspection, we included an indirect measure (perfectionism single category implicit association task; SC-IAT). The SC-IAT and a self-report measure of perfectionism (FMPS) was used in patients with MDD (n = 55), OCD (n = 55), and in healthy controls (n = 64). In replication of previous findings, patients with MDD and OCD differed from healthy controls regarding self-reported perfectionism scores. Furthermore, Bayesian statistics showed that the two patient groups did not differ regarding perfectionistic strivings and only showed differences on perfectionistic concerns, when the doubts about actions subscale-which is also closely related to symptoms of OCD-was included. Contrary to our expectations, the SC-IAT did not discriminate groups. In conclusion, these results give further evidence that self-reported perfectionism may serve as a relevant transdiagnostic process. More studies are needed to assess implicit facets of perfectionism.

Changes in the daily life experience of patients with obsessive-compulsive disorder following mindfulness-based cognitive therapy: Looking beyond symptom reduction using ecological momentary assessment.

The current study examines changes in daily life experiences following mindfulness-based cognitive therapy (MBCT) in a sample of 38 patients with obsessive-compulsive disorder (OCD) and residual symptoms following cognitive behavioral therapy (CBT). Participants were randomized to either an MBCT group (n = 17), or to a psychoeducational group (OCD-EP; n = 21) as an active control condition. Both groups underwent ecological momentary assessment (EMA) six times a day for a period of six consecutive days pre- and posttreatment. Contrary to hypotheses, MBCT participation did not, when compared to OCD-EP, result in significant changes of positive affect, negative affect, acceptance of momentary emotions, or distress associated with obsessive-compulsive (OC) symptoms. In fact, insight into the unreasonableness of OC symptoms improved significantly more in the OCD-EP group compared to MBCT. However, in the MBCT group, the presence of momentary OC symptoms at post assessment predicted increased insight, which indicates an improved ability to detach from OC symptoms in the moments in which they occur. All in all, however, results do not indicate favorable changes in everyday life experiences of OCD patients following MBCT. Owing to the modest sample size, results must be considered preliminary. Implications and directions for future research are discussed.

Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 8-10 Years After Inpatient Treatment.

Obsessive-compulsive disorder (OCD) can be effectively treated by cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Yet, little is known about the long-term effects of inpatient CBT up to one decade after treatment. Thirty patients who had been treated with 12 weeks of intensive inpatient CBT with ERP were examined 8-10 years after their stay in hospital with regard to obsessive-compulsive symptoms, secondary outcomes, and use of healthcare services. Significant (p < .001) improvements in OC symptoms with medium and large effects compared to baseline on the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) and on the Obsessive-Compulsive Inventory (OCI-R) could still be observed, with 20% of the patients reaching remission status. Continuation of exposure exercises after the inpatient stay was the sole significant factor for improved scores at follow-up. The results suggest that OCD does not necessarily take a chronic course. However, maintenance of exposure training seems to be crucial for sustained improvement.

Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial.

We examined the long-term efficacy of mindfulness-based cognitive therapy (MBCT) compared to a psychoeducation group as an active control condition in patients with obsessive-compulsive disorder (OCD) with residual symptoms of OCD after cognitive behavioral therapy. A total of 125 patients were included in a bicentric, interviewer-blind, randomized, and actively controlled trial and were assigned to either an MBCT group (n = 61) or a psychoeducation group (n = 64). Patients' demographic characteristics and the results from our previous assessments have already been reported (Külz et al., 2019). At the 12-month follow-up the completion rate was 80%. OCD symptoms were reduced from baseline to follow-up assessment with a large effect, but no difference was found between groups. Exploratory analyses showed that a composite score of time occupied by obsessive thoughts, distress associated with obsessive thoughts, and interference due to obsessive thoughts differed between groups in the per-protocol analysis, with a stronger reduction in the MBCT group. At the 12-month follow-up, the two groups showed a similar reduction of symptoms. However, preliminary evidence indicates that MBCT has a superior effect on some aspects of OCD. This should be replicated in future studies.

Mindfulness predicts insight in obsessive-compulsive disorder over and above OC symptoms: An experience-sampling study.

Insight in obsessive-compulsive disorder (OCD) is assumed to fluctuate over time. However, temporal variations of insight and its correlates in OCD have never been empirically studied. We used ecological momentary assessment (EMA) to analyze the temporal variation of insight into the unreasonableness of the threat-related core belief (1), into the senselessness of compulsions to prevent this belief from occurring (2), and into the belief, itself, as being due to OCD (3). Furthermore, we analyzed whether worry, self-punishment and mindfulness are associated with these aspects of insight. A total of 50 OCD patients underwent EMA 10 times a day over 6 consecutive days. Data were analyzed using multilevel modelling. Results revealed that multiple time-points within individuals accounted for up to 51.4% of insight variance, indicating a substantial fluctuation of insight over time. Root mean square successive difference (rMSSD) scores indicated significantly higher fluctuation patterns in the doubt/checking dimension as compared to taboo thoughts throughout all aspects of insight. As hypothesized, self-punishment and mindfulness significantly predicted insight into the unreasonableness of the threat-related belief and the senselessness of compulsions to prevent this belief from occurring. Mindfulness demonstrated the greatest predictive value and remained significant after controlling for OC symptoms. Contrary to expectation, worry, as it was measured in our study, was not associated with insight. Besides providing evidence for insight fluctuation, our results indicate that mindfulness-based strategies might be beneficial for increasing insight in OCD.

Implicit approach and avoidance in patients with obsessive-compulsive disorder.

Avoidance is regarded as an important feature for the development and maintenance of obsessive-compulsive disorder (OCD) and is usually assessed using explicit measures such as self-report scales. However, some behavioral schemata are unavailable to introspection, making them partially inaccessible by explicit measures. We used an approach-avoidance task (AAT) as an implicit measure to examine behavioral tendencies in patients with OCD, including patients with checking- and contamination-related symptoms (n = 63), compared with a healthy control group (n = 30). Participants were asked to respond to the color of a stimulus or stimulus frame by pulling a joystick toward themselves or by pushing it away. The stimuli were comprised of checking-related, contamination-related, and neutral pictures and words. Patients with contamination-related symptoms were slower when responding to OCD-related stimuli, independent of approach or avoidance. Unexpectedly, patients with checking-related symptoms were faster at pulling (approaching) and slower at pushing (avoiding) checking-related material compared with neutral stimuli. The slower pushing (avoiding) of checking-related compared with neutral material correlated positively with explicit ratings of avoidance. These results suggest a biased approach-avoidance tendency in patients with checking-related symptoms of OCD, but not in those with contamination-related symptoms of OCD. Future studies are necessary to assess whether the AAT might be useful in the assessment of treatment gains as well as whether it might be a training tool to enhance psychotherapeutic changes in OCD. (PsycINFO Database Record