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Concentrated ERP delivered in a group setting: An effectiveness study
Abstract
The aims of the present study were to evaluate the acceptability and long term gains of a highly concentrated exposure and response prevention (ERP) for obsessive compulsive disorder (OCD). Treatment was individually tailored and delivered in a group format over four consecutive days in an outpatient OCD treatment unit, part of the ordinary specialist health care. A total of 35 patients accepted the offer of treatment; 23 of the patients were classified with “severe” to “extreme” OCD, and 74% of the sample had previously received treatment for their OCD (20% of these with ERP). The results showed that more than 90% of the patients expressed a high degree of satisfaction with the concentrated ERP. At six months follow-up 27 (77%) were classified as recovered and a significant improvement was seen in depressive symptoms as well. The majority of the sample also showed improvement with regard to employment status 12 months after treatment. The results indicate that this highly concentrated treatment may be a feasible format of delivering ERP.
... Concentrated treatment also has the benefit of allowing a patient and their therapist to intensively practice exposure to different triggers, including in the patient's typical day-to-day environment [18]. The Bergen 4-Day treatment (B4DT) was developed to implement ERP treatment for OCD patients in an intensive format, delivering the entire treatment within four consecutive days [19]. Since then, this approach to treatment has been documented to be effective in treating OCD patients within different samples and at different sites [20][21][22]. ...
... Engaging adolescents in mental health treatment is increasingly recognized as an important challenge [30]; therefore, it is of paramount importance to determine effective treatments that are acceptable to teenagers so that they will be willing to engage in their treatment. Past studies of the acceptability of the B4DT showed that this treatment is highly acceptable and evidenced high ratings of client satisfaction with the treatment [19,22], although these data have only been reported in adults. Client satisfaction with the B4DT was not reported in past studies with youth samples [18,23], so whether the B4DT is acceptable to adolescents remains an important unanswered question. ...
... It rates the severity of obsessions and compulsions based on five dimensions: time occupied by symptoms, how the symptoms interfere with daily life, distress, resistance, and control. The CY-BOCS categorizes symptom severity on a scale from 0 to 40, with divisions into subclinical symptoms (0-7), mild symptoms [8][9][10][11][12][13][14][15], moderate symptoms [16][17][18][19][20][21][22][23], severe symptoms [8,[24][25][26][27][28][29][30] and extreme symptoms [31][32][33][34][35][36][37][38][39]. ...
Background
B4DT is a concentrated treatment format with prolonged sessions of exposure and ritual prevention (ERP) delivered over four consecutive days. Two previous open trials demonstrated promising results of the Bergen 4-day treatment (B4DT) for adolescents with obsessive-compulsive disorder (OCD). The aim of the current study was to replicate the initial results with a new sample of adolescents and different therapists at different sites across Norway.
Methods
Forty-three youths participated in treatment program. At pretreatment, posttreatment, and the three-month follow-up, OCD symptoms were assessed using the CY-BOCS interview, while the GAD-7 and PHQ-9 were administered to rate general anxiety symptoms and depressive symptoms. Acceptability and patient satisfaction with the treatment were rated with the CSQ-8.
Results
All symptoms were significantly reduced at posttreatment and follow-up. At posttreatment, 36 patients (85.71%) were defined as responders, while 29 patients (69.05%) achieved remission. At the three-month follow-up, 36 patients (92.3%) were defined as responders, while 33 patients (84.62%) were in remission. CSQ-8 scores indicated that the patients were highly satisfied with the treatment.
Conclusions
The B4DT was successfully replicated in a new sample at different sites across Norway, which indicates that this treatment is generalizable, effective and acceptable to adolescents with OCD.
... Intensive treatment programs have been evaluated for posttraumatic stress disorder (PTSD; Hendriks et al., 2018), anxiety disorders (Pittig et al., 2021), and OCD (Havnen et al., 2014). However, the studies did not focus specifically on older adults, for whom intensive treatment programs are often considered too burdensome. ...
... However, the studies did not focus specifically on older adults, for whom intensive treatment programs are often considered too burdensome. Moreover, the intensive treatment for OCD, which was evaluated among younger adults, was delivered in a group setting (Havnen et al., 2014). The present case study is, therefore, the first description of an individual high-intensive CBT/ERP treatment program for an older adult, who was diagnosed with OCD. ...
... A complicating factor in the case of this patient was the scarcity of research on OCD treatments in older adults. Most studies have evaluated weekly CBT/ERP or intensive CBT/ERP for the treatment of OCD among adults of working age (Carpenter et al., 2018;Havnen et al., 2014). Other studies in older adults focused on other mental disorders and indicated that older adults respond just as well, or even better to psychotherapy than younger adults (Chaplin et al., 2015;Cuijpers et al., 2020;Segal et al., 2018). ...
The prevalence of Obsessive-compulsive disorder (OCD) among older adults varies between .5% and 4.5%. OCD typically develops at a young age, and many clinicians consider the chances of successful treatment in older adults to be minimal based on the chronicity of their symptoms. To date, no randomized controlled trial have been conducted on the effectiveness of treatments for OCD in older adults. This case study describes a high intensive cognitive behavioral therapy (CBT) provided to a 72-year-old man with OCD. This CBT program includes psychoeducation, exposure and response prevention, and cognitive therapy. The treatment was provided by a team of 5 therapists over one week. The patient’s score on the Yale Brown Obsessive-Compulsive Scale decreased from 31 at the start of the treatment to 2 by the end of treatment, which is below the recommended cut-off for a clinical diagnosis. Secondary depressive symptoms, as assessed with the Inventory of Depressive Symptomatology Self-Report, decreased from 57 at the start of treatment, to 1 by the end of treatment, which indicates the absence of depressive symptoms. The treatment gains were maintained with persistent remission until the 18-month follow-up. This study highlights an effective high intensive CBT program for older adults with OCD and challenges the false assumptions that (a) psychological interventions are ineffective for older adults and (b) existing treatments are unsuited for older adults. Future research should investigate the effects of this program in large sample with sufficient power.
... A highly concentrated format of ERP has been developed in Bergen, Norway, where the treatment is delivered over four consecutive days in a group of 3-6 patients with the same number of therapists, (the Bergen 4-day treatment [B4DT]). For a detailed description of the approach, see Havnen et al. 2013, Havnen et al. 2017 In an effectiveness study by Havnen et al. (2014) where 35 patients received this treatment format 77% were classified as recovered at post-treatment and 11% improved, applying the Jacobson and Truax (1991) criteria. The numbers were 74% and 14% respectively at a six-month follow-up. ...
... There was a significant improvement in depressive symptoms and positive changes in occupational interference, maintained at follow-up. This study was replicated in 2017 where 42 patients underwent the same treatment format, delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment format. At post-treatment, 74% of the patients were in remission and 60% had recovered at 6-month follow-up (Havnen et al. 2017). ...
... Comparison between treatment response in Iceland and in Norway(Havnen et al. 2014) ...
Objective:
The purpose of this study was to evaluate the first implementation outside of Norway of the Bergen 4-day treatment for Obsessive Compulsive Disorder (OCD), an innovative and effective treatment format with high acceptance and basically no drop-out.
Method:
Nineteen patients with OCD underwent the treatment at the Icelandic Anxiety Clinic (Kvíðameðferðarstöðin). Of these, 17 of the patients were classified pretreatment with severe to extreme symptoms and 2 were classified with moderate symptoms. 63% of the patients had previously received treatment for OCD (ERP or CBT).
Results:
Mean pretreatment score on Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was 28.79 (SD = 4.42). One week post-treatment mean Y-BOCS score was 9.95 (SD = 3.67). 94.7% of the patients had responded to treatment and 73.7 were in remission according to the international consensus criteria. At 3-month follow-up, the Y-BOCS score was 11.09 (SD = 5.89) where 78.9% of the patients had responded to treatment and 63.2% were in remission.
Conclusions:
All patients expressed high satisfaction with the treatment format, and none of the patients would have preferred longer term treatment. The therapists also expressed satisfaction with the treatment format. The Bergen 4-day treatment for OCD is a very promising treatment for OCD, and can be successfully implemented outside Norway.
... The B4DT is delivered during four consecutive days to a group of 3-6 patients by the same number of therapists, and is often described as "individual treatment delivered in a group setting." Following B4DT, 94% of the patients have responded (Havnen et al., 2014(Havnen et al., , 2017Hansen et al., 2018a), and 68% were recovered at 1-4 years follow-up (Hansen et al., 2018a(Hansen et al., , 2019. In addition, the approach has shown significant effects on comorbid depressive symptoms as well as on generalized anxiety. ...
... In addition, the approach has shown significant effects on comorbid depressive symptoms as well as on generalized anxiety. The B4DT is highly accepted by the patients and there are basically no dropouts (Havnen et al., 2014(Havnen et al., , 2017Hansen et al., 2018a;Kvale et al., 2018). These results can be compared with those achieved by standard ERP in the meta-analysis by Öst et al. (2015), where the response rate was 65% and the remission rate 50% (while often using a more lenient criterion than in the B4DT format studies above). ...
... The B4DT format was developed and introduced as part of standard care in an ordinary outpatient clinical setting with low selection of patients. The average duration of the OCD in the published effectiveness studies was 15.7 years (Hansen et al., 2019), and mean pre-treatment score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al., 1989b), was 25.9 (Havnen et al., 2014(Havnen et al., , 2017Hansen et al., 2018a). This makes the B4DT highly relevant for outpatient units offering treatment to patients with OCD. ...
Sørlandet Hospital in Norway has a history of offering patients with obsessive-compulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at follow-up. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic.
... While OUH employed a protocol for individual exposure and response prevention (ERP) [2] where patients typically are treated over 12-16 weeks, the OCDteam at Haukeland University Hospital, Bergen, has developed a novel treatment format where ERP is delivered during just four consecutive days. Despite the relatively brief treatment, the Bergen 4-day treatment (B4DT) has been shown to yield a good outcome [3][4][5]. At posttreatment assessment the proportion of responders varied from 83% [4] to 93.8% [5] with a weighted mean of 89.4%. ...
... At 6-or 12-month follow-up the mean response rate was 82.4%. The post-treatment remission rate varied between 73.8% [4] and 77.1% [3] with a weighted mean of 76.0%, and at follow-up the average rate was 69.7%. Also, the 4-day format has shown to be acceptable for the patients and has a 'low drop-out rate; 0.7% (only 1 out of 142 patients; [3][4][5]. ...
... The post-treatment remission rate varied between 73.8% [4] and 77.1% [3] with a weighted mean of 76.0%, and at follow-up the average rate was 69.7%. Also, the 4-day format has shown to be acceptable for the patients and has a 'low drop-out rate; 0.7% (only 1 out of 142 patients; [3][4][5]. However, these studies have had small sample sizes (N = 35, 42, and 65) so larger trials are warranted. ...
Background:
Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%.
Methods:
Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format.
Results:
Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD.
Conclusions:
We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.
... The primary objective of the present study is to investigate the long-term outcome of two samples (Havnen, Hansen, ?st, & Kvale, 2014;2017) of 77 consecutive OCD- patients receiving the concentrated B4DT. Based on the 6-month follow-up results in these studies, and the 1 year follow-up in a subsequent study (Hansen et al., 2018) we expected that the post-treatment effect would be maintained at a 4 year follow-up. ...
... A recent unpublished psychometric study of the Norwegian Y-BOCS found that the Norwegian version of the Y-BOCS showed good reliability and validity (Eilertsen et al., Forthcoming). This outcome measure, and others reported in the Havnen et al. (2014;2017) original studies were part of the standard quality control instruments of the health services offered at the outpatient OCD clinic at Haukeland University Hospital. ...
... The primary objective of the present study was to investigate the long-term outcome of two samples (Havnen et al., 2014;2017) of 77 consecutive OCD-patients receiving the concentrated B4DT. These had shown good outcomes, which were maintained at the 6- month follow-up. ...
There are few long-term follow-up studies on psychological treatment of anxiety disorders carried out in clinical mental health settings, so called effectiveness studies. The present paper presents a four year follow-up of patients with obsessive-compulsive disorder treated by the Bergen 4-day treatment (B4DT), a concentrated form of exposure and response prevention (ERP). A total of 77 obsessive–compulsive disorder (OCD) patients received treatment during four consecutive days and were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pre, post, and at follow-ups after 3 and 6 months, and 4 years post-treatment. The Y-BOCS mean score changed from 25.9 at pre- to 10.0 post-treatment and 9.9 at long-term follow-up. The proportion fulfilling the strict international consensus criteria for remission was 73% at post-treatment and 69% at follow-up. When taking declining rate, attrition rate, remission, relapse, and further improvement during the follow-up period into account, 72% were recovered on a long-term basis. A comparison with previously published effectiveness studies of ERP indicated that the 4-day treatment yielded significantly higher proportions of remission at post-treatment and recovery at follow-up, as well as within-group effect size on the Y-BOCS. The implications of these results are discussed.
... The dropout rate for cET was only 1.3% (Havnen et al., 2014(Havnen et al., , 2017. This is remarkably low as compared to the overall dropout rate of 19.7% reported in a meta-analysis of Swift and Greenberg (2012) covering 669 RCTs and almost 84,000 patients. ...
... Since the concentrated exposure treatment (cET) is delivered during 4 consecutive days, it is highly attractive to a substantial number of patients, since they during a very short time may get rid of a severe problem which highly impairs everyday life. This is also reflected in the low declining rate (2.5%) and low drop-out rate (1.3%) in the two Havnen et al. (2014Havnen et al. ( , 2017 studies. Also, the format yields an opportunity for OCD-specialists within a given geographical area to join efforts and work together with severe patients during clearly specified time-slots. ...
... We also wanted to evaluate the patients' acceptance of the treatment as well as attrition, and to compare the results from the 4-day treatment with the long term results reported in a recent meta-analysis (Öst et al., 2015). Based on the 6-month follow-up results in a previous studies (Havnen et al., 2013(Havnen et al., , 2014(Havnen et al., , 2017, as well as the 12-month follow-up data of standard ERP described above, we expected that the effects of cET at post-treatment will be maintained at the 12-monthfollowup, also compared to the results from CBT as reflected in the meta-analysis. ...
The Bergen 4-day concentrated exposure treatment (cET) for obsessive-compulsive disorder (OCD) has proven highly acceptable; with practically no drop-out and a 6 month remission rate of nearly 70%. The aim of the present study was to evaluate long term gains of the approach, and to compare the results to findings from our recent meta-analysis. Sixty-nine of 95 patients consecutively referred to an outpatient clinic in the specialist health care, were offered the Bergen 4-day treatment. Among the 65 who initiated treatment, 60.0% were classified with “severe” to “extreme” OCD. None of the patients dropped-out during treatment. Independent Yale-Brown Obsessive-Compulsive Scale interviews were conducted post-treatment, and at 3- and 12-month follow-up. Using the international consensus criteria, 83.1% responded to treatment at 12-month follow-up, and 67.7% of patients were classified as recovered. Significant changes were also seen in depression, as measured by Patient Health Questionnaire-9, and in generalized anxiety, as measured by Generalized Anxiety Disorder-7 scale. A total of 89% of the patients rated the treatment as very good and 100% would recommend the treatment to a friend. Compared to results in a recent meta-analysis, the Bergen 4-day treatment is favorable in respect to attrition, response and 12-month recovery. In sum the Bergen 4-day treatment is a feasible way to deliver treatment for OCD, and the effects are stable at 12-month follow-up. Implications for dissemination are discussed.
... exposure-based cBts can be delivered in a number of different formats (Öst et al. 2015b), and all patients in the current study received concentrated exposure Treatment (cET) delivered during four consecutive days. one of the hallmarks of this approach is the combination of individually tailored and therapist assisted exposures combined with a group format where the ratio between therapists and patients are 1:1 (havnen 2016;havnen et al. 2013;Havnen et al. 2014). The cET format has been evaluated in a pilot study (Havnen et al. 2013), in an effectiveness study (Havnen et al. 2014) and in a replication of the effectiveness study (Havnen et al. submitted) with very promising results. ...
... one of the hallmarks of this approach is the combination of individually tailored and therapist assisted exposures combined with a group format where the ratio between therapists and patients are 1:1 (havnen 2016;havnen et al. 2013;Havnen et al. 2014). The cET format has been evaluated in a pilot study (Havnen et al. 2013), in an effectiveness study (Havnen et al. 2014) and in a replication of the effectiveness study (Havnen et al. submitted) with very promising results. The format is highly accepted by the patients, and there are basically no drop-outs. ...
... 79% of the total sample was classified as recovered post treatment, 68% as recovered at 3-months follow-up, and 72% as recovered at six months. This is comparable to our previous studies (Havnen et al. 2013(Havnen et al. , 2014. These results are better than typical ERP- ...
Prevalence of Personality DisorDers in Patients with ocD anD relationshiP to treatment outcome espen handeland Øvrehus, anneli sund martinsen, Kristen hagen, Bjarne hansen, Gerd Kvale abstract Objective: as a rule of thumb 30-40% of patients with ocD do not experience clinically relevant change from exposure and response prevention (ERP), and 50% can expect to be classified as recovered post treatment. The evidence is unclear as to whether comorbid personality disorders (PD) might be a factor negatively influencing treatment outcome. The aims of the current study were to investigate if PDs and magnitude of Axis-I diagnoses are related to poorer treatment outcome. Method: 47 ocD patients (15 male) received concentrated exposure therapy (cet) which consists of individually tailored and therapist assisted exposure therapy during 4 consecutive days. The treatment was delivered in a group format with a patient-therapist ration of 1:1. OCD-symptoms were assessed with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before treatment, at 1-week post-treatment, and at 3-and 6-months follow-up. Post treatment interviews were conducted by an independent rater. Patients were screened for PDs with Standardized Assessment of Personality, Abbreviated Scale (SAPAS). Results: Pre-treatment the PD group did not have more severe OCD-symptoms as compared to the group without. Post treatment 79% of the patients were classified as recovered, and there were no differences between patients with or without PD. These results were maintained for the patients without PD at three and six months, whereas the comparable results for the PD-group were 38% and 54%. Conclusions: It is concluded that the 4-day treatment format is feasible also for patients with PD. 1 ocD-team, haukeland university hospital, Bergen, norway 2 hospital of molde, molde, norway 3 norwegian university of science and technology, trondheim, norway
... The Bergen 4-Day Treatment (B4DT) format is delivered during four consecutive days in groups for 3-6 patients with a 1:1 ratio between patients and therapists (Havnen et al., 2014;2017;;Launes et al., 2019;Riise et al., 2016Riise et al., , 2018. Routine clinical data and a randomized control trial have found a remission rate of 75%, while an additional 10% were improved, and 15% showed no significant change one week after treatment (Havnen et al., 2014(Havnen et al., , 2017Launes et al., 2019), which are largely maintained after four years (Hansen et al., 2019). ...
... The Bergen 4-Day Treatment (B4DT) format is delivered during four consecutive days in groups for 3-6 patients with a 1:1 ratio between patients and therapists (Havnen et al., 2014;2017;;Launes et al., 2019;Riise et al., 2016Riise et al., , 2018. Routine clinical data and a randomized control trial have found a remission rate of 75%, while an additional 10% were improved, and 15% showed no significant change one week after treatment (Havnen et al., 2014(Havnen et al., , 2017Launes et al., 2019), which are largely maintained after four years (Hansen et al., 2019). The first day of the B4DT consists of a group session with psychoeducation and planning of individual exposure tasks. ...
Response inhibition has previously been suggested as an endophenotype for obsessive–compulsive disorder (OCD), evidenced by studies showing worse task performance, and altered task-related activation and connectivity. However, it’s unclear if these measures change following treatment. In this study, 31 OCD patients and 28 healthy controls performed a stop signal task during 3 T functional magnetic resonance imaging before treatment, while 24 OCD patients and 17 healthy controls were rescanned one week and three months after concentrated exposure and response prevention over four consecutive days using Bergen 4-Day Format. To study changes over time we performed a longitudinal analysis on stop signal reaction time and task-related activation and amygdala connectivity during successful and failed inhibition. Results showed that there was no group difference in task performance. Before treatment, OCD patients compared to controls showed less inhibition-related activation in the right inferior frontal gyrus, and increased functional connectivity between the right amygdala and the right inferior frontal gyrus and pre-supplementary motor area. During error-processing, OCD patients versus controls showed less activation in the pre-SMA before treatment. These group differences did not change after treatment. Pre-treatment task performance, brain activation, and connectivity were unrelated to the degree of symptom improvement after treatment. In conclusion, inferior frontal gyrus hypoactivation and increased fronto-limbic connectivity are likely trait markers of OCD that remain after effective exposure therapy.
... The Bergen 4-day treatment (B4DT) is delivered during 4 consecutive days, with the 2 middle days allocated to therapist-assisted ERP, followed by 3 weeks of selfadministered ERP. The B4DT has been shown to be highly effective for patients with OCD, with remission rates of w75% 1 week after treatment (28,29) and stable improvements after 4 years (30,31). Given the treatment's rapid effect on OCD symptoms and very high rate of remission, it provides an ideal context to look at brain changes associated with symptom reduction. ...
... The B4DT is an individually tailored and therapist-assisted exposure-based treatment format delivered during 4 consecutive days. Effectiveness studies of both adult and adolescent patients with OCD (29,33) have shown that w90% of patients respond and 75% remit 1 week after treatment. The improvements in symptom severity are durable for 3 months to 4 years of follow-up (30,31) and have been replicated in independent samples of patients and therapists (28,34), new clinics (35), and a randomized controlled trial (36), and the B4DT is currently being implemented in Sweden, Iceland, and the United States. ...
Background
Exposure and response prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD), but it is unclear how symptom reduction is related to changes in the brain. We aimed to determine the effects of a 4-day concentrated ERP program (Bergen 4-Day Treatment, B4DT) on the static and dynamic functional connectome in OCD patients.
Methods
Thirty-four OCD patients (25 unmedicated) underwent resting-state functional magnetic resonance imaging the day before the B4DT, and 28 (21 unmedicated) were rescanned after one week. Twenty-eight healthy controls were also scanned for baseline comparisons and 19 were rescanned after one week. Static and dynamic graph measures were quantified to determine network topology at the global, subnetwork, and regional level (including efficiency, clustering, between-subnetwork connectivity, and node flexibility in module allegiance). The Yale-Brown Obsessive Compulsive Scale was used to measure symptom severity.
Results
Twenty-four (86%) patients responded to treatment. We found significant group × time effects in frontoparietal-limbic connectivity (η2p=0.19, p=.03) and flexibility of the right subgenual anterior cingulate cortex (η2p=0.18, p=.03) where, in both cases, unmedicated patients showed significant decreases while healthy controls showed no significant changes. Healthy controls showed increases in global and subnetwork efficiency and clustering coefficient, particularly in the somatomotor subnetwork.
Conclusions
Concentrated ERP, in unmedicated OCD patients, leads to decreased connectivity between the frontoparietal and limbic subnetworks and less flexibility of the connectivity of the sgACC, suggesting a more independent and stable network topology. This may represent less limbic interference on cognitive control subnetworks after treatment.
... All patients are recommended to discontinue use of anxiolytics before treatment starts. The treatment is thoroughly described in Havnen, Hansen, Öst, and Kvale (2014;. ...
... Therefore, it might be relevant for future studies to investigate sensitivity using different machine learning approaches to investigate the topic further. Previous studies have shown that the B4DT yields solid treatment outcome (Hansen et al., 2018a,b;Havnen et al., 2014;Kvale et al., 2018) and it can be argued that reducing treatment time to four consecutive days might reduce the effect of some external factors, such as significant life events and time effects. The thorough training of the therapists required in this format, and the fact that therapists can help each other out during the course of treatment might also help reduce therapist effects. ...
It has been debated whether concentrated exposure and response prevention (ERP) is too difficult to tolerate for some patients. This report therefore uses quality assurance data looking into whether sensory processing sensitivity (SPS) affects treatment outcome among patients with OCD. SPS is a personality trait regarding heightened levels of emotional reactivity and deeper cognitive processing of emotional stimuli. Patients received concentrated exposure treatment for obsessive-compulsive disorder (OCD). They were assessed with one of the most widely used questionnaires for measuring SPS, the Highly Sensitive Person Scale (HSPS). Analyses tested whether HSPS scores at pre-treatment affected treatment outcome, and if sensitivity changed from pre-to posttreatment. Results revealed there was no significant relation between sensitivity and treatment outcome after controlling for pre-treatment levels of OCD, depression, and anxiety. HSPS scores were significantly reduced after treatment (d=1.22). This indicates that concentrated ERP is suitable also for patients scoring high on HSPS, and the main conclusion is that patients’ sensitivity does not hinder treatment response.
... One way to overcome many of the difficulties seen in patients with ASD would be to deliver the CBT treatment over a few days instead of, as in this study, on average 33 weeks. Several studies on an intensive 4-day CBT treatment for OCDpatients without ASD have shown large reductions on the Y-BOCS from baseline to posttreatment (14.92 to 20.14 points) (Hansen, Kvale, Hagen, Havnen, & Öst, 2018;Havnen, Hansen, Öst, & Kvale, 2014, 2017. In this intensive treatment, patients receive treatment in groups of 5-6 with a 1:1 patient-therapist ratio. ...
... Treatment is delivered over four consecutive days, with days 2-4 dedicated to exposure exercises. Patients are then instructed to continue doing exposure exercises for three weeks and receive a booster session three months after treatment (Havnen et al., 2014). The studies to date have not included patients with co-occuring ASD, but by using an intensive treatment format, it might be possible to circumvent several of the difficulties seen in ASD: low compliance with homework assignments, the need for extra time during exposure exercises, and need for therapist-led exposure exercises throughout treatment. ...
Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) commonly co-occur. Adapted CBT for OCD in adults with ASD has not previously been evaluated outside the United Kingdom. In this study, 19 adults with OCD and Asperger syndrome were treated using an updated CBT protocol. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Secondary outcomes were self-rated obsessive-compulsive symptoms, depressive symptoms, quality of life, and daily functioning. Participants were assessed at baseline, at 10 weeks during treatment, at post-treatment and at 3-month follow-up. Treatment response and remission were determined according to international consensus definitions. There were large reductions on the YBOCS at post-treatment, and improvements were sustained at follow-up (d=1.2). Self-rated OCD symptoms and depressive symptoms also showed statistically significant reductions. Improvements in general functioning and quality of life were non-significant. At follow-up, three participants were responders and one was in full remission. Adapted CBT for OCD in adults with co-occuring ASD is associated with significant reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes were modest; few patients were completely symptom free, and general functioning and quality of life did not improve significantly. We identify and discuss the need for further treatment refinement for this vulnerable patient group.
... One form of concentrated CBT that has been developed is the Bergen 4-Day Treatment (B4DT). Originally developed for the treatment of obsessive-compulsive disorder (OCD) [18], The B4DT has demonstrated promising treatment effects in a randomized controlled trial (RCT) for patients with OCD [19]. The B4DT has been adapted to the treatment of PD and showed promising results in a pilot study [20] and when implemented at new treatment sites [21,22]. ...
Introduction
Bergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study.
Aim
The aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort (n = 30), initially assessed at three months post-treatment.
Method
Thirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month follow-up, and longer-term follow-up (with a mean time of 18 months).
Results
There was a significant reduction in panic disorder symptoms from pretreatment to longer-term follow-up (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]). The Panic Disorder Severity Scale (PDSS) mean decreased from 19.83 (SD = 0.64, 95% CI [18.55, 21.12]) before treatment, to 4.37 (SD = 0.64, 95% CI [2.98, 5.76]) post-treatment, followed by further decreases at the 3-month follow-up to a mean of 2.84 (SD = 0.64, 95% CI [1.45, 4.22]), and at the longer-term follow-up to 2.60 (SD = 0.64, 95% CI [1.33, 3.87]). There was no significant difference in symptom severity between the 3-month and 18-month assessments, indicating a sustained improvement (p <.001). At the 18-month follow-up, 90% of the patients were classified as being in remission. There were also significant reductions in symptoms of depression (d = 1.44) and generalized anxiety (d = 1.62) that were maintained at the longer-term follow-up assessment.
Conclusion
The results from the current study indicated that the treatment effects of B4DT are stable over time and that the treatment format appears to be promising for PD. Confirming these preliminary results in rigorous study designs is needed.
Trial registration
The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord-2021/209619).
... However, OCD treatment with exposure and response prevention (ERP) is effective for many patients, either in traditional formats or in brief, intensive or concentrated formats [5][6][7]. The Bergen 4-Day Treatment (B4DT) is an example of concentrated treatment that is effective in treating OCD [8][9][10][11][12]. ...
Background
Research suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD.
Methods
Forty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9.
Results
In this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9.
Conclusion
Insomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted.
Trial registration
The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).
... ⇒ Participants will receive treatment at clinics located in different parts of Stockholm, which may be an obstacle for recruitment and retention. Open access from uncontrolled trials indicate that approximately 90% of patients reliably improved [14][15][16][17] and that 70% were in remission 4 years after treatment. 16 A recent RCT (n=48) showed that B4DT was superior both to a self-help book for OCD and a wait list control. ...
Introduction
Individual cognitive behavioural therapy (CBT) with exposure and response prevention is an effective treatment for obsessive–compulsive disorder (OCD). However, individual CBT is costly and time-consuming, requiring weekly therapy sessions for 3–4 months. A 4-day intensive version of CBT for OCD delivered in group format has been recently developed in Norway (Bergen 4-day treatment, B4DT). B4DT has shown promising results in several uncontrolled and one small, randomised trial, but its non-inferiority to the gold standard treatment has not been established.
Methods and analysis
This single-blind, randomised controlled trial including 120 patients (60 per arm) will compare B4DT to individual CBT. The primary outcome is the blind assessor-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We hypothesise that B4DT will be non-inferior to gold standard CBT 15 weeks after treatment start. The non-inferiority margin is set at four points on the Y-BOCS. Secondary outcomes include time to treatment response, cost-effectiveness, response and remission rates, drop-out rates and adverse events.
Ethics and dissemination
This study has been approved by the Swedish Ethical Review Authority. Hypotheses were specified and analysis code published before data collection started. Results from all analyses will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials and Consolidated Health Economic Evaluation Reporting Standards irrespective of outcome.
Trial registration number
NCT05608278 .
... The Bergen 4 day-treatment (B4DT) is a concentrated form of CBT in which patients receive concentrated exposure treatment in four consecutive days. The format has been demonstrated to be an effective treatment for obsessive-compulsive disorder (OCD) at posttreatment and at 3-month, 1-year, and 4-year follow-ups [12][13][14][15]. The B4DT has been adapted for the treatment of PD, and a pilot study demonstrated promising results [16]. ...
Introduction
The Bergen 4-Day Treatment (B4DT) is a concentrated treatment with individually tailored exposure exercises. The format has shown promising results in the treatment of panic disorder.
Aim
The aim of the current study was to investigate the effectiveness of the B4DT in a large sample in a rural clinical setting.
Method
Fifty-eight patients with panic disorder were consecutively included using an open trial design. The primary outcome measure was the Panic Disorder Severity Scale. The Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 were used as secondary outcome measures. Assessments were conducted at pretreatment, posttreatment, and 3-month follow-up. Treatment satisfaction was measured at posttreatment using the Client Satisfaction Questionnaire-8.
Results
There was a significant reduction in symptoms of panic disorder from pre- to posttreatment (d = 3.36) and from pretreatment to follow-up (d = 3.63). At posttreatment and follow-up, 72.4% and 81.0% of patients, respectively, were classified as in remission. Patients reported high treatment satisfaction, and there were significant reductions in symptoms of generalized anxiety and depression.
Conclusion
The results from the current study replicated the findings from previous studies using a larger sample size. The findings indicate that the B4DT is a promising treatment format for panic disorder. The study also demonstrated that the treatment format can be successfully implemented in new rural clinics.
... The validation of a Norwegian translation of the CSQ-8 is particularly timely. First, over the last few years, it has increasingly been used as a measure of patient satisfaction [14,15,[34][35][36][37][38][39][40][41][42][43]. Second, several registered trials plan to use the questionnaire as an outcome measure [44][45][46][47][48]. ...
Background
Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated.
Methods
We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated.
Results
The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach’s alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed.
Conclusion
Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.
... Groups of 3-6 OCD patients received the B4DT over four consecutive days (Havnen et al., 2014). Day 1 consisted of a three-hour group session with psychoeducation and planning exposure tasks. ...
Background
The dorsal anterior cingulate cortex (dACC) plays an important role in the pathophysiology of obsessive-compulsive disorder (OCD) due to its role in error processing, cognitive control and emotion regulation. OCD patients have shown altered concentrations in neurometabolites in the dACC, particularly Glx (glutamate+glutamine) and tNAA (N-acetylaspartate+N-acetyl-aspartyl-glutamate). We investigated the immediate and prolonged effects of exposure and response prevention (ERP) on these neurometabolites.
Methods
Glx and tNAA concentrations were measured using magnetic resonance spectroscopy (1H-MRS) in 24 OCD patients and 23 healthy controls at baseline. Patients received concentrated ERP over four days. A subset was re-scanned after one week and three months.
Results
No Glx and tNAA abnormalities were observed in OCD patients compared to healthy controls before treatment or over time. In OCD patients with versus without comorbid mood disorders, lower Glx concentrations were detected at baseline (t(38)=-2.28, d=-1.00, p=0.028). Glx increased after one week of treatment within OCD patients with comorbid mood disorders (t(30)=-3.09, d=-1.21, p=0.004). Patients with childhood or adult onset differed in the change over time in tNAA (F(2,40)=7.24, ɳ²p=0.27, p=0.004): concentrations increased between one week after treatment and follow-up in the childhood onset group (t(39)=-2.43, d=-0.86, p=0.020), whereas tNAA concentrations decreased between baseline and follow-up in patients with an adult onset (t(42)= 2.78, d=1.07, p=0.008).
Limitations
Our OCD sample size allowed the detection of moderate to large effect sizes only.
Conclusion
ERP induced changes in neurometabolites in OCD seem to be dependent on mood disorder comorbidity and disease stage rather than OCD itself.
... Trained therapists deliver this over four consecutive days with a 1:1 ratio between patients and therapists. The results in clinical practice and randomized controlled trials suggest a remission rate of around 70% (31)(32)(33)(34), and recovery rates are retained 4 years after treatment (35). ...
Background: Subtle differences in white matter microstructure have been found in obsessive-compulsive disorder (OCD) compared to controls using diffusion tensor imaging (DTI), but it is unclear if and how this change after treatment. The primary aim of this pre-registered study was to investigate white matter integrity between OCD patients and controls and changes after concentrated exposure and response prevention (ERP).
Methods: Fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and mean diffusivity (MD) were estimated using FMRIB Software Library (FSL). The images were registered to a study-specific template using a longitudinal pipeline based on full tensor information in DTI-TK. Voxel-based analysis was performed using tract-based spatial statistics (TBSS). Using SPSS, we compared the integrity in three bilateral regions of interest (ROI), the sagittal stratum, posterior thalamic radiation and cingulum, in 32 OCD patients and 30 matched healthy controls at baseline. Patients received a four-day concentrated ERP format. We investigated longitudinal changes in 26 OCD patients and 22 healthy controls at 3months follow-up using repeated-measures ANOVA. Exploratory t-tests were conducted for AD and MD. Secondary hypothesis used linear regression to investigate if baseline FA predict treatment outcome 3 months later, and if patients with illness onset before 18 years of age would show lower FA in sagittal stratum. Finally, we performed sensitivity analysis on medication and comorbidity influences on FA.
Results: Three months after treatment, 77% of the patients were in remission. Contrary to our hypotheses, we did not find any significant differences in FA, RD, AD or MD between the groups before treatment, nor significant group by time effects in any of the ROI. None of the baseline FA measures significantly predicted treatment outcome. Illness onset before 18 years of age did not significantly predict FA in the sagittal stratum. Adjusting for medication or comorbid anxiety or mood disorder did not influence the results.
Conclusions: Although concentrated ERP in OCD lead to high remission, we did not find significant long-term changes by DTI. Future studies will benefit from using larger sample sizes and multi-shell diffusion-weighted imaging when investigating white matter microstructure in OCD and underlying neurobiological mechanisms of treatment.
... Trained therapists deliver this over four consecutive days with a 1:1 ratio between patients and therapists. The results in clinical practice and randomized controlled trials suggest a remission rate of around 70% (31)(32)(33)(34), and recovery rates are retained 4 years after treatment (35). ...
... The 2 middle days were used for exposure treatment (eFigure 1 in Supplement 2). Effectiveness studies in routine clinical care [19][20][21][22] as well as a randomized clinical trial 23 have demonstrated that 90% of patients with OCD respond to ERP treatment delivered in this format and that 70% are recovered at 4-year follow-up, 24 based on the international consensus criteria. 25 DCS was administered both days of exposure treatment. ...
Importance
Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD.
Objective
To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD.
Design, Setting, and Participants
The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Participants were adult outpatients with difficult-to-treat OCD. A total of 220 potential participants were referred, of whom 36 did not meet inclusion criteria and 21 declined to participate. Patients had either relapsed after (n = 100) or not responded to (n = 63) previous ERP treatment. A total of 9 specialized OCD teams within the public health care system in Norway participated, giving national coverage. An expert team of therapists from the coordinating site delivered treatment. Inclusion of patients started in January 2016 and ended in August 2017. Data analysis was conducted February to September 2019.
Interventions
All patients received individual, concentrated ERP treatment delivered during 4 consecutive days in a group setting (the Bergen 4-day treatment format) combined with 100 mg DCS, 250 mg DCS, or placebo.
Main outcomes and Measures
Change in symptoms of OCD and change in diagnostic status. Secondary outcomes measures included self-reported symptoms of OCD, anxiety, depression, and quality of life.
Results
The total sample of 163 patients had a mean (SD) age of 34.5 (10.9) years, and most were women (117 [71.8%]). They had experienced OCD for a mean (SD) of 16.2 (10.2) years. A total of 65 patients (39.9%) were randomized to receive 100 mg DCS, 67 (41.1%) to 250 mg of DCS, and 31 (19.0%) to placebo. Overall, 91 (56.5%) achieved remission at posttreatment, while 70 (47.9%) did so at the 12-month follow-up. There was no significant difference in remission rates among groups. There was a significant reduction in symptoms at 12 months, and within-group effect sizes ranged from 3.01 (95% CI, 2.38-3.63) for the group receiving 250 mg DCS to 3.49 (95% CI, 2.78-4.18) for the group receiving 100 mg DCS (all P < .001). However, there was no significant effect of treatment group compared with placebo in obsessive-compulsive symptoms (250 mg group at posttreatment: d = 0.33; 95% CI, −0.10 to 0.76; 100 mg group at posttreatment: d = 0.36; 95% CI, −0.08 to 0.79), symptoms of depression and anxiety (eg, Patient Health Questionnaire–9 score among 250 mg group at 12-month follow-up: d = 0.30; 95% CI, −0.17 to 0.76; Generalized Anxiety Disorder–7 score among 100 mg group at 12-month follow-up: d = 0.27; 95% CI, −0.19 to 0.73), and well-being (250 mg group: d = 0.10; 95% CI, −0.42 to 0.63; 100 mg group: d = 0.34; 95% CI, −0.19 to 0.86). No serious adverse effects were reported.
Conclusions and Relevance
In this study, DCS did not potentiate ERP treatment effect, but concentrated ERP treatment was associated with improvement.
Trial Registration
ClinicalTrials.gov identifier: NCT02656342
... The results from this RCT provide evidence that most OCD patients treated with B4DT, delivered at another site than the originators' clinic, achieve highly comparable outcomes at post-treatment and 3-month follow-up, as a number of open trials have reported (Havnen et al., 2014(Havnen et al., , 2017Hansen et al., 2018;Kvale et al., 2018;Davíðsdóttir et al., 2019;Launes et al., 2019a,b). In addition, the study replicated previous findings concerning refusal and attrition rates. ...
The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) was recently tested in a randomized controlled trial, where the results showed that the B4DT was more effective than a self-help intervention (SH) and a waiting list condition (WL). Patients in the SH and WL condition still in need of treatment after the first intervention (N = 26; 13 from each condition) were offered the B4DT. None of the patients declined participation, and there were no dropouts. At post-treatment 59.5% were in remission, 31.0% had treatment response, and 9.5% showed no change. At 3-month follow-up 71.4% were in remission, 19.0% had treatment response, and 9.5% showed no change. There were also significant improvement in self-reported symptoms of OCD, generalized anxiety symptoms, and depressive symptoms. The results are in line with what we previously have found for the B4DT in a number of effectiveness studies. In addition, the results indicate that the patients who previously had received an unsuccessful SH intervention and patients who had first been in a WL condition, profited as much as patients who had received the B4DT as the initial intervention. Implications for clinical guidelines and for dissemination of the B4DT are discussed.
... 81 More recently, researchers are investigating the use of a 4-day intensive ERP treatment for OCD which has the potential of addressing barriers of time and cost. 84,85 Although initial results are promising, 86,87 further large-scale RCTs are needed to demonstrate the treatment's efficacy. ...
Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological perspective and summarizes the evidence supporting the efficacy of ERP across child and adult populations. Next, we discuss predictors of ERP treatment outcome and discuss implementation strategies designed to improve feasibility and adoption. Finally, strategies to improve treatment dissemination are discussed.
... The main purpose is to summarize and evaluate the participants' effort and achievements, to provide psychoeducation focusing on relapse prevention and to plan daily selfadministered ERP tasks for the next 3 weeks. For a detailed description of the B4DT format see Havnen, Hansen, Öst, and Kvale [43] and Riise et al. [17]. ...
Findings suggest that increased levels of family accommodation are associated with a poorer treatment outcome in obsessive–compulsive disorder (OCD). A concentrated treatment format, the Bergen 4-day treatment (B4DT), has previously demonstrated promising results in the treatment of adolescents with OCD. The present paper examined changes in family accommodation and investigated whether family accommodation predicted outcome, in a sample of 63 adolescents (age range 11–18) participating in the B4DT. There were significant reductions on CY-BOCS and FAS from pre- to post-treatment and from pre-treatment to follow-up (p < 0.001), with large within-group effect sizes on both measures. Pre-treatment levels of symptom severity or family accommodation was not found to predict outcome at post-treatment or at follow-up. Less OCD-related functional impairment at pre-treatment predicted a better outcome at both post-treatment and follow-up. The findings suggest that the B4DT significantly reduces OCD-symptoms regardless of pre-treatment levels of family accommodation or OCD severity.
... Data from these patients are subsequently stored in a clinical data registry. The current paper included patients from this registry who fulfilled all of the following criteria: (1) completed the Bergen concentrated exposure treatment (cET; Hansen, Hagen, € Ost, Solem & Kvale, 2018;Hansen, Havnen, Hagen, € Ost & Kvale, in press;Havnen, Hansen, € Ost & Kvale, 2014. The Bergen 4day OCD treatment delivered in a group setting: (1) 12-month follow-up.; ...
There is a lack of research on the relation between obsessive‐compulsive disorder (OCD) and resilience. Dispositional resilience, as described and defined in literature on hardiness, consists of three facets, namely beliefs about having control in everyday living, having a sense of purpose or commitment, and a positive attitude toward challenges. This study explores associations between dispositional resilience (measured with the Dispositional Resilience Scale (DRS‐15‐R)), symptom severity, and treatment outcome in a sample of 89 patients treated with concentrated exposure therapy (cET), and compares the findings with scores from two reference groups (students and soldiers). The patient group had significantly lower resilience scores than the two reference groups. Weak correlations were observed between dispositional resilience and OCD symptoms. Differences in dispositional resilience were weakly related to remission status at follow‐up (odds ratio of 1.11). Furthermore, resilience improved from pre‐ to post‐treatment (Cohen's d of 0.65). Our results imply that patients’ initial resilience score does not hinder nor facilitate treatment effects to a great extent in this format of ERP treatment.
... Further, affected individuals who show some levels of resistance can be occasionally managed by modifying treatment approaches prescribed by stage II subjects, such as adding other drugs (e.g. clomipramine) to existing schemes or delivering intensive forms of EX/RP [86] in partial hospitalisation programs [87] that can also target at family accommodation [29] issues. The FDA has recently approved a specific deep TMS device for OCD based on a 6-week double blind multicentre RCT in patients resistant to SSRI or CBT showing both efficacy (54.7% in active TMS vs. 26.6% in sham TMS) and tolerability (10.6% drop out rate) [4]. ...
Recent changes to the diagnostic classification of obsessive–compulsive disorder (OCD), including its removal from the anxiety/neurotic, stress-related and somatoform disorders chapters of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases 11th Revision (ICD-11), are based on growing evidence of unique pathogenic signatures and linked diagnostic and treatment approaches. In this review, we build on these recent developments and propose a ‘clinical staging model’ of OCD that integrates the severity of symptoms and phase of illness for personalised case management. A clinical staging model is especially relevant for the early identification and management of subthreshold OCD - a substantial and largely neglected portion of the population who, despite having milder symptoms, experience harms that may impact personal relationships, work-related functioning and productivity. Research on the pathogenesis, classification and management of such cases is needed, including the development of new outcomes measures that prove sensitive to changes in future clinical trials. Early intervention strategies in OCD are likely to yield better long-term outcomes. Keywords: Obsessive–compulsive disorder, Clinical staging, Early intervention, Neuroprogression, Cognitive functioning, Biological markers, Treatment outcome, Transdiagnostic framework
... The treatment is delivered during four consecutive days in groups of 3-6 patients with the same number of therapists. The results show that 83% of the patients are reliably improved and 68% remitted at 6-month follow-up, with very low declining rate and practically no dropout (Havnen et al., 2014(Havnen et al., , 2017. A recent 4-year follow-up found that 69% of the patients were recovered 4 years after treatment (Hansen et al., 2018). ...
The current article reports on the findings from a pilot treatment study on panic disorder (PD) with or without agoraphobia. Consecutively referred patients were included and treated with the Bergen 4-day treatment format. Twenty-nine patients were included, primarily from unsuccessful treatment courses in the Norwegian specialist mental health care system, either ongoing or previously. Prior to treatment, only 34% were able to work but at 3-month follow-up 93% were able to do so. The proportion achieving reliable change on the panic severity measure was 76% post-treatment and 90% at follow-up. The remission rate was 72% at both assessments. These effects are significantly higher than those reported for six standard CBT studies in the literature using the same primary outcome measure (Panic Disorder Severity Scale). It is concluded that the Bergen 4-day treatment is a promising treatment approach for PD, and a randomized controlled trial is warranted.
... The current meta-analytic evidence suggests that treatment with cognitive behavioral therapy (CBT) involving exposure and response prevention (ERP) helps an average of approximately 50% of patients recover (95% confidence interval between 44 and 56%), significantly more than those only receiving serotonin reuptake inhibitors (SRIs) alone, the other first-line treatment for OCD [4,5]. A recently developed concentrated exposure treatment reports considerably higher remission rates of7 5% after treatment [6,7]. The immense personal and societal costs of OCD shows the pressing need to better understand the disorder and possible treatment mechanisms, in order to improve clinical outcomes for those who do not respond to current treatments [8]. ...
Purpose of review:
Specific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues.
Recent findings:
The contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhibitors (SRIs). Contamination symptoms have been related to increased amygdala and insula activation in a few studies, while sexual/aggressive/religious symptoms have also been related to more pronounced alterations in the function and structure of the amygdala. Increased pre-treatment limbic responsiveness has been related to better outcomes of CBT, but most imaging studies show important limitations and replication in large-scale studies is needed. We review possible reasons for the strong limbic involvement of the amygdala in patients with more sexual/aggressive/religious symptoms, in relation to their sensitivity to CBT.
Summary:
Symptom dimensions may predict treatment outcome, and patients with sexual/religious/aggressive symptoms are at a greater risk of not starting or delaying treatment. This is likely partly due to more shame and perceived immorality which is also related to stronger amygdala response. Competently delivered CBT is likely to help these patients improve to the same degree as patients with other symptoms.
... The 4-day cET-treatment does not include any specific sleep interventions. For a detailed description of the treatment procedure and the cET-format, see Havnen, Hansen, Haug, Prescott, and Kvale (2013) and Havnen et al. (2014). ...
Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.
... Hence, there might be an added benefit to combine a group setting with one-to-one contact between a therapist and a patient. One RCT in adults with OCD shows the benefits of an individually delivered intensive E/RP in a group setting [95]. ...
Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling, and common disorder. In this paper, we describe evidence-based treatments in treatment-naïve and treatment-refractory pediatric OCD patients. We conducted a PubMed search to identify randomized controlled trials, reviews, and expert guidelines. The evidence for cognitive behavior therapy (CBT) and specific serotonin reuptake inhibitors (SSRIs) among treatment-naïve patients is substantial and shows that both treatments are effective. Head-to-head trials in pediatric OCD only show that CBT is significantly more effective than SSRI. The evidence among CBT and SSRI non-responders is limited. One trial among CBT non-responders showed that both continued CBT and switching to an SSRI are effective strategies. Likewise, one trial among SSRI non-responders showed that augmenting with CBT is necessary. Evidence of treatments for treatment-refractory pediatric OCD is lacking. We describe the treatments available and evidence from studies of adult OCD. Evidence for emerging treatments such as modifying CBT and glutamatergic drugs is also described.
The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been evaluated and implemented nationwide in Norway. Its effectiveness has yet to be fully established in other countries. A total of 86 patients with OCD underwent the treatment at the Icelandic Anxiety Centre (KMS) from 2018 to 2023. Of these, 61.6% were classified as having severe symptoms, and 38.4% with moderate symptoms. Of the sample, 72.1% had previously received psychological treatment for OCD and 86.0% had at least one comorbid disorder, depression being the most common (50.0%). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered pre-treatment, posttreatment, and at 3-month follow-up, along with measures on general anxiety, depression, and occupational impairment. The mean score on Y-BOCS was 30.5 (SD = 3.6) pre-treatment, 10.6 (SD = 4.1) posttreatment and 10.9 (SD = 5.4) at 3-month follow-up. By the end of treatment, 94.9% of the patients had responded and 68.0% were in remission. At the 3-month follow-up, 92.5% were responders and 67.9% remitters. Participants were satisfied with the treatment and had improved in terms of occupational functioning, which was maintained at follow-up. These preliminary results suggest that the B4DT may be a swift and effective treatment format for OCD.
The Bergen Four Day Treatment (B4DT) is a concentrated treatment for OCD that has demonstrated promising effectiveness in Nordic country samples. The B4DT is delivered over four days and provides individual treatment in a group context. The effectiveness of the B4DT for OCD has not been tested outside Nordic countries. The current pilot study evaluated the feasibility and the potential effectiveness of B4DT in a different culture and health-care system in the United States. Findings from 48 adults with OCD who completed the B4DT indicated that OCD, anxiety, and depression symptom severity significantly decreased from pre- to post-treatment, and gains were maintained at six month follow-up. The Yale-Brown Obsessive Compulsive Scale scores were reduced from moderate to subclinical; specifically, the average scores of 27.0 (pre-treatment) fell to 11.7 (post-treatment), 12.7 (3-month follow-up), and 13.7 (6-month follow-up). The B4DT was rated as highly acceptable by the US patients. Over 95% of the patients stated that they would recommend the treatment to a friend. These findings provide the first preliminary evidence for the generalizability of the B4DT to patients outside Nordic countries. Cultural and context-dependent issues that affected this dissemination pilot study are discussed in addition to future clinical and research directions.
Objective
To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD.
Methods
We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient’s home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists.
Results
In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P <0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties.
Conclusions
In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
This chapter describes empirically supported intensive treatment protocols for pediatric obsessive-compulsive disorder (OCD). The chapter begins with a brief review of the epidemiology of OCD in youth, followed by a description of cognitive behavioral therapy (CBT) with exposure and response/ritual prevention (ERP), the gold standard treatment approach for OCD. Following this, brief and intensive treatment protocols are discussed, including intensive family-based CBT, 5-day intensive ERP, the Bergen 4-Day treatment, and prolonged intensive ERP. The chapter concludes with a case study to highlight the application of an intensive treatment approach. Recommendations for refractory cases and future directions for research and clinical care are also presented.
Background
Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive–compulsive disorder. Using this model, this study reports a successful treatment process of a 53‐year‐old female with ORD.
Case Presentation
The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4‐week hospitalization period, high‐intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety‐seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention.
Conclusion
Following a seven‐sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High‐frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.
The need for effective treatments for obsessive-compulsive disorder (OCD) in childhood is evident given that as many as 50% of the adults with OCD report symptom onset before age 15. Despite the growing evidence supporting the efficacy of Exposure and Response Prevention (ERP) for youth with OCD, children seeking services for their OCD symptoms often do not receive ERP because of difficulties with treatment accessibility. Brief time-intensive treatment programs may be a feasible treatment option for children and their families who do not have access to ERP treatment and/or live in an area where therapists trained in ERP are limited. To evaluate the initial efficacy, feasibility, and acceptability of a brief, five-day intensive ERP program for pediatric OCD, eight children with OCD were randomized to a one-week, two-week, or three-week baseline period in a single-case, non-concurrent multiple-baseline experimental design. In most cases, there were clinically significant improvements in OCD symptoms with the implementation of treatment; moreover, treatment gains were maintained at 3-month follow-up. Children and families perceived the program to be acceptable, feasible, and beneficial. This study extends the support for the efficacy and feasibility of a five-day intensive treatment program for pediatric OCD.
Introduction
This article presents two international pilot studies examining brief intensive group cognitive behavioral therapy (BIG-CBT) for pediatric OCD.
Aims
1) to examine treatment outcome of BIG-CBT in two countries, 2) to explore the influence of potential predictors on treatment outcome.
Methods
Study 1 (n= 59) was a retrospective study executed in country 1, study 2 (n=17) was a prospective study performed in country 2 (total: 76 participants). The pilot studies were carried out in academic centers for child and adolescent psychiatry. BIG-CBT consisted of 5-day CBT in a group format, with exposure and response prevention as the main element.
Results
Both studies showed a significant decrease from pre-to post-treatment on the Children's Yale-Brown Obsessive Compulsive Scale mean scores. In study 1, 44% of participants met the criterion for treatment responder at post-treatment (≥35% improvement), in study 2 this was 59% at post-treatment and 41% at 3-month-follow-up. In both studies, age, gender and baseline OCD severity did not significantly predict treatment outcome.
Conclusion
The results of these two international pilots of BIG-CBT indicate that brief, intensive treatment has the potential to become a valuable addition to standard clinical care for pediatric OCD.
Obsessive–compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive–compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale–Brown Obsessive–Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale–Brown Obsessive–Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive–compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive–compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive–compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
Pediatric obsessive-compulsive disorder is a chronic and impairing condition that often persists into adulthood. This review refreshes the state of support for psychosocial treatments and the predictors or moderators that relate to their efficacy and evaluates how the literature has improved since the last update in 2014. A secondary goal is to propose an additional framework for the categorization of studies based on central research questions rather than treatment format. Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the Journal of Clinical Child and Adolescent Psychology evidence-based treatment evaluation criteria. Findings again converge in support of cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with obsessive-compulsive disorder. Family-focused CBT is now well-established. A number of other treatments including CBT+ D-Cycloserine, CBT+ Sertraline, CBT+ positive family interaction therapy, and technology-based CBT are now probably efficacious. Demographic, clinical, and family factors are consistent predictors of CBT outcome with conflicting findings for neurocognitive predictors. The field has advanced significantly since the last review, but there is still room for improvement. Some of the conclusions that can be drawn may be limited by our evaluation criteria. Future directions are proposed to advance treatment outcome research beyond a focus on which treatments work to exploring factors that account for how and why they work.
Recommended psychological treatment for obsessive-compulsive disorder (OCD) is cognitive behavioral therapy (CBT) including exposure with response prevention (ERP). Previous studies have identified few consistent predictors of both short- and long-term treatment outcomes in CBT for OCD. The aim of the current study was to investigate the relation between the combined burden of three post-treatment predictors (subclinical symptoms of OCD, anxiety, and depression) and long-term treatment outcome. A total of 97 patients with a diagnosis of OCD from an outpatient clinic in Norway completed a concentrated four-day group treatment of ERP for OCD. Results revealed that patients in the high-risk group had 2.5 times the risk (odds ratio = 10.1) of having OCD at follow-up compared to patients in the low risk group. Pre-treatment levels of depression, anxiety and OCD were not significantly related to follow-up status. The results indicate an advantage of a combined post-treatment predictor model over single pre-treatment predictors. Furthermore, we argue that the intensive four-day treatment format provides a unique setting for investigating predictors of treatment outcome.
Background:
In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days.
Aims:
The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014).
Method:
Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included.
Results:
The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures.
Conclusions:
This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.
This study evaluated the effectiveness of a concentrated exposure and response prevention (ERP) treatment for adolescents with obsessive-compulsive disorder (OCD). Twenty-two adolescents with OCD (range 11 – 17 years) received therapist-assisted ERP during four consecutive days, followed by a three week period of self-administered ERP. Treatment was delivered to 2-3 patients and their parents simultaneously at an outpatient clinic for child and adolescent psychiatry as part of standard health care. OCD-symptoms were assessed at pre-treatment, post-treatment, 3- and 6-month follow-up. The results demonstrated that patients had significant reduction in OCD-symptoms from pre- to post-treatment and the gains were maintained at follow-up. 91% (n=20) were classified as responders at post-treatment, and 77% (n=17) at six-month follow-up. Remission rates were 73% (n=16) at post-treatment and 68% (n=15) at six-month follow-up. OCD-related impairment and symptoms of anxiety and depression were significantly reduced at post-treatment and follow-up. The results suggest that concentrated ERP is a promising treatment for adolescents with OCD.
Objective: Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder. The established treatment of choice is exposure and response prevention (ERP) and it has been demonstrated that ERP is effective across a range of different treatment formats. The aim of the present pilot study was to evaluate the effectiveness and patients’ acceptability of individually delivered ERP in a group setting. In the current paper we describe the main features of this novel approach as compared to standard individual ERP and other group approaches.
Method: Six consecutively referred OCD patients (aged 23-59) were included, five with OCD since childhood or early teens. The treatment was run four successive days, with prolonged exposure training on Day two and Day three,designed as one long session. This procedure was partly modeled over the one-session approach to treatment of specific phobias.
Results: All patients expressed high acceptance of the treatment procedures, content and format. Mean Y-BOCS score at pre-treatment was 23.5 points, at post-treatment 5.7 points and at six months follow-up 6.3 points.
Conclusions: Intensive group ERP appears to be a promising treatment format and future larger scale studies are
warranted.
Whether it’s dogs, spiders, blood, heights or some other fear, specific phobias are one of the most prevalent mental health problems, affecting as many as one in eight people. In recent years, cognitive-behavioral therapy (CBT) has emerged as particularly effective in treating young people and adults with specific phobias. And of these methods, one-session treatment stands out as a long-lasting, cost-effective intervention of choice. Intensive One-Session Treatment of Specific Phobias not only provides a summary of the evidence base, it also serves as a practical reference and training guide. This concise volume examines the phenomenology, epidemiology, and etiology of phobias, laying the groundwork for subsequent discussion of assessment strategies, empirically sound one-session treatment methods, and special topics. In addition, expert contributors address challenges common to exposure therapy, offer age-appropriate guidelines for treating young clients, and describe innovative computer-assisted techniques. Organized to be read individually or in sequence, chapters delve into key areas, including: Evidence-based assessment and treatment of specific phobias in children, adolescents, and adults.One-session treatment theory and practice with children, adolescents, and adults.Handling difficult cases of specific phobias in youth.Interventions for specific phobias in special populations.Training and assessing therapists in one-session treatment.Ethical issues in considering exposure. Intensive One-Session Treatment of Specific Phobias is an essential resource for researchers, clinicians, and graduate students in child, school, clinical, and counseling psychology; social work; and general and special education.
The development and initial psychometric properties of the Cognition Checklist (CCL), a scale to measure the frequency of automatic thoughts relevant to anxiety and depression, are described in this article. Item analyses of the responses of 618 psychiatric outpatients identified a 14-item depression and a 12-item anxiety subscale that were significantly related, respectively, to the revised Hamilton Rating Scales for Depression and Anxiety. Patients diagnosed according to the
Diagnostic and Statistical Manual of Mental Disorders (
DSM-III; American Psychiatric Association, 1980) with anxiety disorders had higher mean CCL anxiety scores than patients with
DSM-III depression disorders who, in turn, had higher mean CCL depression scores. The validity of the CCL supports the content-specificity hypothesis of the cognitive model of psychopathology (Beck, 1976). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy for OCD patients in a community-based, general Norwegian outpatient clinic. The sample consisted of 54 patients diagnosed with OCD. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory (STAI-S) were administered before treatment, after treatment and at 3- and 12-month follow-ups. Analyses with mixed models for repeated measurements showed that group behavioural therapy offered to OCD patients significantly improved ratings of obsessive-compulsive symptoms, depression and anxiety. These improvements were maintained at 3- and 12-month follow-ups and an additional reduction in obsessive-compulsive symptoms was observed from post-treatment to 3-month follow-up. However, the delayed effect of therapy was no longer present at 12-month follow-up. The results also revealed that the patients had a lower chance for an increased outcome category (e.g. from unchanged to improved or recovered) with high scores on STAI-S at the given observation times (post-treatment, 3- and 12-months follow-ups). Depressive symptoms (BDI) at post-treatment and follow-ups had no significant influences on the three categories of outcome for OCD. In conclusion, the results indicate that behavioural group therapy can successfully be delivered to patients with considerable comorbidity in a real world setting conducted by therapists with limited training in the CBT.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
When a meta-analysis on results from experimental studies is conducted, differences in the study design must be taken into consideration. A method for combining results across independent-groups and repeated measures designs is described, and the conditions under which such an analysis is appropriate are discussed. Combining results across designs requires that (a) all effect sizes be transformed into a common metric, (b) effect sizes from each design estimate the same treatment effect, and (c) meta-analysis procedures use design-specific estimates of sampling variance to reflect the precision of the effect size estimates.
Exposure and ritual prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), yet the intensive treatment schedule often described is not transportable to many settings. In the present study, the authors examined whether a twice-weekly (TW) ERP program reduced the effectiveness of intensive (IT) ERP. Forty OCD patients received 15 sessions of ERP: 20 received daily treatment over 3 weeks and 20 received twice weekly therapy over 8 weeks. Results indicated that both programs were effective. The effect of therapy schedule was moderate, with a trend toward more improvement in the intensive group at posttreatment. No differences were found at follow-up; some evidence of relapse was found with IT but not TW.
Designed to be used in conjunction with its companion online patient workbook, this Therapist Guide includes supporting theoretical, historical and research background information, diagnostic descriptions, differential diagnoses, session by session treatment outlines, case examples, sample dialogues, practice assignments, and tailored application to the vast variety of presentations and nuances of the disorder. It contains the 'nuts and bolts' of how to provide the treatment and is a comprehensive resource for therapists. It is an invaluable guide for clinicians in overcoming the barriers and difficulties that are part and parcel of every treatment.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), the essential features of obsessive-compulsive disorder are recurrent obsessions or compulsions of significant severity. Obsessions are “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress” (APA, 1994, p. 418). Compulsions are “repetitive behaviors... or mental acts... the goal of which is to prevent or reduce anxiety or distress” (p. 418). This DSM-IV conceptualization of OCD offers no fundamental reformation of the previous construct, but there have been some noteworthy shifts of emphasis that reflect recent thinking about the disorder.
A Monte Carlo simulation examined the performance of a recently available full information maximum likelihood (FIML) estimator in a multiple regression model with missing data. The effects of four independent variables were examined (missing data technique, missing data rate, sample size, and correlation magnitude) on three outcome measures regression coefficient bias, R-2 bias, and regression coefficient sampling variability. Three missing data patterns were examined based on Rubin's missing data theory: missing completely at random, missing at random, and a nonrandom. pattern. Results indicated that FIML estimation was superior to the three ad hoc techniques (listwise deletion, pairwise deletion, and mean imputatiom) across the conditions studied, FM parameter estimates generally had less bias and less sampling variability than the three ad hoc methods.
Obsessive-compulsive disorder is ranked by the WHO as among the 10 most debilitating disorders and tends to be chronic without adequate treatment. The only psychological treatment that has been found effective is cognitive behavior therapy (CBT). This meta-analysis includes all RCTs (N=37) of CBT for OCD using the interview-based Yale-Brown Obsessive Compulsive Scale, published 1993 to 2014. The effect sizes for comparisons of CBT with waiting-list (1.31), and placebo conditions (1.33) were very large, whereas those for comparisons between individual and group treatment (0.17), and exposure and response prevention vs. cognitive therapy (0.07) were small and non-significant. CBT was significantly better than antidepressant medication (0.55), but the combination of CBT and medication was not significantly better than CBT plus placebo (0.25). The RCTs have a number of methodological problems and recommendations for improving the methodological rigor are discussed as well as clinical implications of the findings.
Copyright © 2015 Elsevier Ltd. All rights reserved.
A Monte Carlo simulation examined the performance of a recently available full information maximum likelihood (FIML) estimator in a multiple regression model with missing data. The effects of four independent variables were examined (missing data technique, missing data rate, sample size, and correlation magnitude) on three outcome measures: regression coefficient bias, R 2 bias, and regression coefficient sampling variability. Three missing data patterns were examined based on Rubin’s missing data theory: missing completely at random, missing at random, and a nonrandom pattern. Results indicated that FIML estimation was superior to the three ad hoc techniques (listwise deletion, pairwise deletion, and mean imputation) across the conditions studied. FIML parameter estimates generally had less bias and less sampling variability than the three ad hoc methods.
Maximum likelihood algorithms for use with missing data are becoming common-place in microcomputer packages. Specifically, 3 maximum likelihood algorithms are currently available in existing software packages: the multiple-group approach, full information maximum likelihood estimation, and the EM algorithm. Although they belong to the same family of estimator, confusion appears to exist over the differ-ences among the 3 algorithms. This article provides a comprehensive, nontechnical overview of the 3 maximum likelihood algorithms. Multiple imputation, which is fre-quently used in conjunction with the EM algorithm, is also discussed. Until recently, the analysis of data with missing observations has been dominated by listwise (LD) and pairwise (PD) deletion methods (Kim & Curry, 1977; Roth, 1994). However, alternative methods for treating missing data have become in-creasingly common in software packages, leaving applied researchers with a wide range of data analytic options. In particular, three maximum likelihood (ML) esti-mation algorithms for use with missing data are currently available: the multi-ple-group approach (Allison, 1987; Muthén, Kaplan, & Hollis, 1987) can be imple-mented using existing structural equation modeling (SEM) software; Amos (Arbuckle, 1995) and Mx (Neale, 1995) offer full information maximum likelihood STRUCTURAL EQUATION MODELING, 8(1), 128–141 Copyright © 2001, Lawrence Erlbaum Associates, Inc.
Anxiety is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association
(Diagnostic and Statistical Manual of Mental Disorders, 2000)) as an “apprehensive anticipation of future danger or misfortune
accompanied by a feeling of dysphoria or somatic symptoms of tension” (American Psychiatric Association (Diagnostic and Statistical
Manual of Mental Disorders, 2000 p. 820)). The anxiety disorders in the DSM-IV include panic disorder with and without agoraphobia,
generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, and obsessive compulsive disorder.
Measures for evaluating anxiety disorders can be useful in clinical practice and research as a tool for measuring change due
to treatment, comparing disorder severity and symptom presentation across groups, motivating patients by systematically discussing
the extent of their symptoms and impairment, and informing the clinician of symptom presentation and areas of impairment in
each individual patient. This chapter is designed to aid clinicians and researchers in choosing empirically driven measures
to guide their clinical and research endeavors for each of the aforementioned anxiety disorders. Whenever appropriate, measures
are reprinted to facilitate this process.
KeywordsAnxiety-GAD-OCD-Panic disorder-Social anxiety-Rating scales-Questionnaires-Assessment-Psychiatry
The development and shaping of a general scale to assess client/patient satisfaction is reported. The scale, the CSQ, was constructed empirically by the authors. The CSQ is a response to several problems and issues that currently cloud the measurement of consumer satisfaction in health and human service systems. These problems and issues in assessing satisfaction are described. Finally, we present practical expriences to date in using the CSQ along with general psychometric qualities of the scale and correlations of CSQ results with client characteristics, service utilization, and service outcomes.
Consistent findings suggest that exposure and response prevention (ERP) procedures are highly effective in treating obsessive-compulsive disorder (OCD). However, the studies that have reported success with this intervention have employed numerous variations in treatment procedures. Four general variations have been (1) whether the exposure sessions were supervised by the therapist or conducted by the patient on his or her own, (2) whether in vivo or imaginal exposure was used, (3) whether exposure stimuli were presented, beginning with the least or the most anxietyevoking, and (4) whether response prevention involved the complete or partial abstinence from ritualizing. Whereas a few authors have addressed the relative efficacy of these procedural variations within single studies, results have been largely equivocal. We employed meta-analytic methods to quantitatively examine the degree of symptom improvement associated with the aforementioned variations of ERP. A total of 38 trials from 24 controlled and uncontrolled studies were included in the meta-analysis. Effect sizes were calculated as the standardized within-group change from pre- to posttreatment, a procedure that varies from traditional meta-analytic methods and likely yielded inflated estimates of treatment efficacy. Our results suggested that therapist-supervised exposure was more effective than self-controlled exposure. Further, the addition of complete response prevention to exposure therapy was associated with better outcome than partial or no response prevention. In reducing symptoms of anxiety, the combination of in vivo and imaginal exposure was superior to in-vivo exposure alone. Findings are discussed in terms of advancing the effectiveness of ERP in the treatment of OCD.
Four hundred and fifty college students rated the credibility of the rationales and procedural descriptions of two therapy, three placebo, and one component-control procedure frequently used in analogue outcome research. The rating scale was designed to assess both the credibility and the expectancy for improvement generated by the rationales. The results indicated that the control conditions were, in general, less credible than the therapy conditions. Implications for outcome research are briefly discussed.
This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families completed the week-long treatment and symptoms improved significantly as measured by self- and parent-report forms, as well as the Children's Yale-Brown Obsessive-Compulsive Scale, F(2, 22)=45.67, p<.05. Total CY-BOCS scores decreased significantly from pretreatment (M=28.00, SD=4.24) to posttreatment [M=16.00, SD=6.0, F(1, 11)=34.38, p<.05] and from posttreatment to 5-month follow-up [M=11.5, SD=7.3; F(1, 11)=12.94, p<.05]. This level of improvement was consistent with other intensive treatments for pediatric OCD. The study suggests that the 5-day program is a promising treatment for children with OCD who do not have access to local providers.
To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents.
Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008.
Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good.
The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.
Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive-compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta-analysis of the effectiveness of group CBT/ERP for OCD.
A systematic literature search was conducted and studies were meta-analysed by means of the Cochrane Review Manager Program with measures of i) pre- to post-effect sizes (ES) and ii) between-group ES in comparison with different control conditions. Outcome was primarily measured on the Y-BOCS and ES was calculated in the form of Cohens d.
Thirteen trials were included in the meta-analysis. The overall pre-post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT.
Group CBT is an effective treatment for OCD, but more studies are needed to compare the effectiveness of group and individual treatment formats.
The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.
The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
Studied internal consistencies of the 1961 and 1978 versions of the Beck Depression Inventory in two different samples of psychiatric patients. The alpha coefficient for the 598 inpatients and outpatients who were administered the 1961 version was .88, and the alpha coefficient for the 248 outpatients who were self-administered the 1978 version was .86. The patterns of corrected item-total correlations were also similar, and it was concluded that the internal consistencies of both versions were comparable.
A computer-assisted telephone system using digitized human speech was developed to administer two rating scales for obsessive-compulsive disorder. For 18 patients, scores derived with this system agreed well with scores from human administration of the scales by telephone and paper-and-pencil scales returned by mail. This approach provides reliable, low-cost, and instantaneous data acquisition.
The most common effective treatments for obsessive-compulsive disorder include clomipramine, fluoxetine, and exposure-based behavior therapy. A meta-analysis was conducted on the results from 25 appropriate treatment studies (1975-1991). All three treatments were significantly effective for most of the outcome variables (overall severity, anxiety, depression). Exposure was not significantly effective for reducing depressed mood. More treatment outcome studies are needed before a clearly superior treatment or combination of treatments can be statistically determined.
The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
A series of seven studies was conducted by the authors and their colleagues to produce an efficient measure of service satisfaction that can easily be related to symptom level, demographic characteristics, and type and extent of service utilization. The resulting measure, the Service Evaluation Questionnaire (SEQ) is a brief, global index that has excellent internal consistency and solid psychometric properties. Data from an extensive SEQ field study can be used as a comparison base for future applications of the two SEQ component scales, the CSQ-8 and the SCL-10. A new hypothesis has emerged from this series of studies that will guide future research: Service recipients may find if difficult to formally express dissatisfaction in the face of significant caring--however ineffectual--when the technical capacity to offer definitive treatment is not yet fully developed and when criteria for evaluating the efficacy of treatment are not yet crystal clear.
A number of qualitative and meta-analytic reviews point to the efficacy of psychotherapeutic and pharmacological interventions for obsessive-compulsive disorder (OCD). In this article, we report a multidimensional meta-analysis of psychological and pharmacological treatment studies for OCD published between 1980 and 2001, examining a range of variables not previously meta-analyzed, including exclusion rates and exclusion criteria, percent of patients improved or recovered post-treatment, mean post-treatment symptomatology, and long-term outcome. These additional metrics provide a more nuanced view of the strengths and limitations of the existing data and their implications for clinical practice. Behavioral and cognitive-behavioral therapy, and a range of pharmacological interventions, lead to substantial improvement for the average patient, with individual psychotherapies and clomipramine and other Serotonin reuptake inhibitors faring best across multiple metrics. However, OCD symptoms persist at moderate levels even following adequate treatment course, and no replicable data are available on maintenance of gains for either form of treatment at 1 year or beyond. Future research should track recruitment and exclusion of study participants, include more comorbid patients, and focus on longer-term follow-up using multiple indices of outcome. More research on combined pharmacological and psychotherapeutic interventions is also indicated.
Controlled outcome studies investigating the efficacy of psychological treatments for obsessive-compulsive disorder (OCD) have employed different methods of determining the clinical significance of treatment effects. This makes it difficult to draw conclusions regarding the absolute and relative efficacy of psychological treatments for OCD. To address this issue, standardized Jacobson methodology for defining clinically significant change was applied to recent psychological outcome trials for OCD. The proportion of asymptomatic patients following treatment was also calculated. When recovery is defined by Jacobson methodology, exposure and response prevention (ERP) appears the most effective treatment currently available (50-60% recovered). However, when the asymptomatic criterion is used as the index of outcome, ERP and cognitive therapy have low and equivalent recovery rates (approximately 25%).
Though there are effective psychological and drug treatments for obsessive-compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.
Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.
Administration of psychological questionnaires via the Internet has gained popularity in recent years and touts many advantages. However, before questionnaires that were originally developed as paper-and-pencil measures can be confidently administered over the Internet, it is necessary to document the equivalence of the paper and computer-generated versions [American Psychological Association. (1986). Guidelines for computer-based tests and interpretations. Washington, DC: American Psychological Association; Cohen, R.J., Swerdlik, M.E., & Smith, D.K. (1992). Psychological testing and assessment (2nd ed.). Mountain View, CA: Mayfield Publishing; Cronbach, L.J. (1990). Essentials in psychological testing (5th ed.). New York: Harper Collins; Meier, S. (1994). The chronic crisis in psychological measurement and assessment: A historical survey. San Diego: Academic Press; Schulenberg, S.E., & Yutrzenka, B.A. (2001). Equivalence of computerized and conventional versions of the Beck Depression Inventory- II (BDI-II). Current Psychology: Developmental, Learning, Personality, Social, 20, 216-230]. The current study tested this equivalence for the Obsessive Compulsive Inventory [Foa, E.B., Kozak, M.J., Salkovskis, P.M, Coles, M.E., & Amir, N. (1998). The validation of a new obsessive compulsive disorder scale: The obsessive-compulsive inventory. Psychological Assessment, 10(3), 206-214] and the Obsessive Beliefs Questionnaire-44 [Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory-Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527-1543] in an unselected student sample. Study results support the equivalence of these measures of obsessive compulsive disorder (OCD) symptoms and beliefs independent of administration method (paper versus secure project website). These findings create new opportunities for conducting OCD-related research online.
This case series describes the use of an intensive 5-day treatment for obsessive-compulsive disorder (OCD) with three adolescents. The treatment is based on traditional cognitive-behavioral therapy consisting primarily of exposures and response prevention (ERP) and involves 10 sessions over 5 days. In addition, the treatment emphasizes instructing the adolescent and the parents on how to conduct ERP at home following the completion of the 5 days of therapy. The treatment is designed for adolescents who do not have local access to mental health practitioners with expertise in ERP for OCD. The three patients who participated in the experimental program each experienced substantial improvements in their OCD symptoms and overall functioning. The present study suggests that brief, 5-day intensive treatment may be an effective means of delivering CBT for adolescents with OCD and may be of use to mental health practitioners who provide services to large catchments.
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