Psychological treatment of obsessive compulsive disorder: an update.

OBJECTIVE: The objective of this article is to provide an update on current psychological treatment for obsessive compulsive disorder (OCD). CONCLUSIONS: Cognitive behaviour therapy (CBT), incorporating exposure and response prevention, remains the non-pharmacological treatment of choice for OCD. Recent developments highlight the importance of family involvement in adult OCD treatment, and the use of alternative 'third-wave' interventions. Internet-delivered CBT may provide an opportunity to overcome barriers to effective treatment, such as distance and lack of trained clinicians.

Randomized controlled trial of an early intervention programme for adolescent anxiety disorders.

OBJECTIVE: To assess the effectiveness of an indicated early intervention and prevention programme for anxiety disorders when conducted by school staff. METHOD: A total of 260 students in their first year of high school with self-reported anxiety symptoms >1 SD above the mean score of a normative sample were randomly allocated on the basis of their school to an intervention condition led by school staff or to a monitoring condition. RESULTS: There was little difference between conditions at the 2 year and 4 year follow up on self-reported symptoms, and no difference on diagnosis or health-care use. CONCLUSIONS: Outcomes associated with indicated prevention programmes led by school staff may not be as strong as those produced by specialist mental health staff. More work is needed to delineate models by which evidence-based treatments can be effectively used in schools.

The changing prevalence and severity of obsessive-compulsive disorder criteria from DSM-III to DSM-IV.

OBJECTIVE: Relative to other mental disorders, the prevalence of obsessive-compulsive disorder (OCD) in the general population is not well established. Some epidemiological surveys have determined the prevalence of DSM-III OCD, but this is one of the first reports, to the authors' knowledge, of DSM-IV OCD's prevalence. METHOD: Data from the Australian National Survey of Mental Health and Well-Being, a nationally representative epidemiological survey of mental disorders, were analyzed. The prevalence and associated characteristics of DSM-IV OCD were identified, and then the data were rescored for DSM-III OCD. Cases defined by each system were compared. RESULTS: The 12-month prevalence of DSM-IV OCD was 0.6%, considerably less than found in surveys employing DSM-III diagnostic criteria. DSM-IV OCD showed significantly higher levels of comorbidity, disability, health service use, and treatment received. CONCLUSIONS: Changes in the reported prevalence and severity of OCD between DSM-III and DSM-IV cases are most likely a function of the differences in diagnostic criteria between DSM-III and DSM-IV.

Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation.

PURPOSE: To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). RESEARCH METHOD/DESIGN: A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. RESULTS: The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. CONCLUSION/IMPLICATIONS: Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience.

The presence, predictive utility, and clinical significance of body dysmorphic symptoms in women with eating disorders.

BACKGROUND: Both eating disorders (EDs) and body dysmorphic disorder (BDD) are disorders of body image. This study aimed to assess the presence, predictive utility, and impact of clinical features commonly associated with BDD in women with EDs. METHODS: Participants recruited from two non-clinical cohorts of women, symptomatic and asymptomatic of EDs, completed a survey on ED (EDE-Q) and BDD (BDDE-SR) psychopathology, psychological distress (K-10), and quality of life (SF-12). RESULTS: A strong correlation was observed between the total BDDE-SR and the global EDE-Q scores (r = 0.79, p < 0.001). Multivariate analyses demonstrated that participants with probable EDs (n = 61) and BDD (n = 23) scored higher on 28 of the 30 BDDE-SR items compared to healthy controls (n = 173; all p < 0.05), indicating greater severity of BDD symptoms. BDD participants also scored higher than ED participants on 15 of the 30 BDDE-SR items (all p < 0.05). The remaining 15 items that ED and BDD participants scored similarly on (all p > 0.05) measured appearance checking, reassurance-seeking, camouflaging, comparison-making, and social avoidance. In addition to these behaviors, inspection of sensitivity (Se) and specificity (Sp) revealed that BDDE-SR items measuring preoccupation and dissatisfaction with appearance were most predictive of ED cases (Se and Sp > 0.60). Higher total BDDE-SR scores were associated with greater distress on the K-10 and poorer quality of life on the SF-12 (all p < 0.01). CONCLUSIONS: Clinical features central to the model of BDD are common in, predictive of, and associated with impairment in women with EDs. Practice implications are that these features be included in the assessment and treatment of EDs.

Pre-existing antidepressants and the outcome of group cognitive behaviour therapy for social phobia.

OBJECTIVE: This is a naturalistic treatment outcome study investigating the impact of pre-existing antidepressant use on the effectiveness of group cognitive behaviour therapy (CBT) for social phobia. METHOD: Of the 133 participants who completed the CBT program, 49 reported taking antidepressants (CBT + AD group), while 84 reported not taking antidepressants (CBT group). The treatment program involves 40 h of structured, group-based CBT over 7 weeks. The dependent measures included the Social Phobia Scale and Social Interaction Anxiety Scale, the Fear of Negative Evaluation Scale, the Depression, Anxiety and Stress Scale and the Short Form-12. RESULTS: Both the CBT + AD group and the CBT group improved significantly across treatment on all dependent measures. There were no significant differences between the groups on any outcome measure and the rate of improvement from pre- to post-treatment for both groups did not differ. CONCLUSIONS: Pre-existing antidepressants did not significantly enhance or detract from the positive treatment outcome of a structured, group-based CBT program for social phobia.

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.