Comparing effects of detached mindfulness and cognitive restructuring in obsessive-compulsive disorder using ecological momentary assessment.

Ecological momentary assessment (EMA) has been shown to be a valid and sensitive measure of treatment effects in obsessive-compulsive disorder (OCD). As part of a clinical trial, this EMA study deals with a comparison of two treatment conditions, that is, cognitive restructuring (CR) and detached mindfulness (DM). EMA data from n = 39 OCD patients were available from a randomized clinical trial on the effectiveness of CR and DM. Smartphone-based EMA sampling spread over 4 days each before and after treatment, with 10 random prompts per day and a 2-week intervention of either CR or DM. We tracked CR strategies (e.g., questioning an appraisal by re-evaluating risk), DM strategies (e.g., allowing one's thoughts to come and go), and application of newly learned strategies during Post-Treatment EMA. Although there was a trend towards DM strategies being applied more often during Pre-Treatment EMA than CR strategies, we did not find differences during Post-Treatment EMA between CR and DM regarding frequency or difficulty of application and experienced relief. As expected, we found a clear pre-post increase for all CR and DM behaviours except for one DM item. However, we did not find a treatment-specific increase of CR and DM behaviours; that is, both interventions equally well promoted a seemingly general treatment effect. Despite the ecological validity of EMA, however, social desirability effects cannot be ruled out, so that this conclusion must be handled cautiously. Further research is needed to replicate and generalize our results.

A study on treatment sensitivity of ecological momentary assessment in obsessive-compulsive disorder.

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness and cognitive restructuring for obsessive-compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms and influencing factors in participants' everyday lives. Thirty-nine participants were included in the final analyses. EMA sampling involved a smartphone and comprised 4 days with 10 random prompts per day both before (Pre-Treatment EMA) and after the completion of a 2-week clinical intervention of either detached mindfulness or cognitive restructuring (Post-Treatment EMA) that participants had been randomly allocated to. The EMA questionnaire included items on the frequency of obsessions, subjective burden due to obsessions, perceived current stress, emotions, and on the frequency of compulsions and other dysfunctional behaviors. Descriptive Pre-Treatment EMA results highlight the importance of compulsions and emotional states of tension/discomfort in OCD. Pre-Post comparisons showed a significant reduction of avoidance behavior, obsessions, and burden due to obsessions, with a nonsignificant trend also indicating a reduction of compulsions. There was no pre to post effect concerning emotions. This study adds to the existing research on OCD symptoms and offers further evidence in confirmation of established theoretical models of OCD. Also, our results can be taken as evidence for treatment sensitivity of the EMA method in OCD. Further research is needed to replicate, broaden, and generalize our results.

A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder.

OBJECTIVE: Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions. DESIGN: We conducted a randomized waitlist-controlled trial. n = 43 participants were randomly assigned to either DM or CR. Out of those participants, n = 21 participants had been previously assigned to a two-week waitlist condition. MATERIALS AND METHODS: In both conditions, treatment comprised four double sessions within two weeks. Assessment took place at baseline (Pre1), after treatment (Post) and four weeks after the end of treatment (FU). There was a second baseline assessment (Pre2) in the waitlist group. Independent evaluators were blinded concerning the active condition. Adherence and competence ratings for the two therapists were obtained from an independent rater. RESULTS: 40 patients completed the treatment. Two patients dropped out because of exacerbated depression. There were no further adverse events. Both CR and DM were shown to be superior to waitlist and equally effective at reducing OCD symptoms from pre to post assessment as measured with the Y-BOCS (CR: d = 1.67, DM: d = 1.55). In each of the two treatment conditions, eight patients (40%) exhibited a clinical significant change at post assessment. CONCLUSIONS: The results of this clinical trial suggest the potential efficacy of DM as a stand-alone intervention for OCD, however, our findings need to be interpreted with caution. Results indicate that both CR and DM should be considered as possible alternative treatments for OCD, whereas the working mechanisms of DM have yet to be elucidated.