Cognitive-behavioral therapy for obsessive–compulsive disorder: A non-randomized comparison of intensive and weekly approaches

Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA.
Journal of Anxiety Disorders (Impact Factor: 2.96). 10/2008; 22(7):1146-58. DOI: 10.1016/j.janxdis.2007.12.001
Source: PubMed


This study examined the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for adults with obsessive-compulsive disorder (OCD). Sixty-two adults with OCD received either 14 sessions of weekly (n=30) or intensive CBT (n=32; daily psychotherapy sessions) in a non-randomized format. Assessments were conducted at Pre-treatment, Post-treatment, and 3-month Follow-up by raters who were blind to treatment group at the Pre-treatment assessment. Intensive and weekly CBT were similar in efficacy at Post-treatment and Follow-up and associated with large treatment effect sizes. Since many people with OCD do not have access to trained CBT providers, intensive treatment may be a viable option in such cases.

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    • "However, hoarding disorder now has its own classification criteria (American Psychiatric Association, 2013), separate to OCD, and requires a different approach to treatment (see Tolin, Frost, Steketee, & Muroff, 2015). A combination of all the above programs is a time-intensive residential, home-based or outpatient program which provides, on average, 16 hours of intensive CBT over one or two weeks (Abramowitz , Foa, & Franklin, 2003; Jónsson, Kristensena, & Arendtc, 2015; Oldfield, Salkovskis, & Taylor, 2011; Storch et al., 2007). "
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    ABSTRACT: Little data exist to inform the treatment of severe or treatment refractory obsessive-compulsive disorder (OCD) in an inpatient or residential setting. We aimed to determine effect size of inpatient, residential or day-patient program in people with OCD. Studies were selected if they were conducted in an inpatient, day-patient or residential setting; were using the Yale Brown Obsessive Compulsive Scale (Y-BOCS) as an outcome measure; treatment included cognitive behavior therapy; it involved adult patients; and had a sample size of at least 20. We identified 19 studies with a total of 2306 participants at admission. We extracted the mean and standard deviation pre-admission and at discharge. The overall reduction was 10.7 points (95% CI: 9.8-11.5, z=24.2 p<0.001) with an effect size, Hedges g, of 1.87. Being married or cohabiting consistently predicted better outcomes, and symptoms of hoarding or comorbid alcohol misuse consistently predicted worse outcomes. Clients with severe or treatment refractory OCD can make significant improvements with intensive residential or inpatient therapy but little is known either about its long term benefits or cost effectiveness compared with an alternative. Programs are offered internationally with a variety of inclusion criteria. We discuss how such programs might be optimized.
    Full-text · Article · Nov 2015 · Journal of Obsessive-Compulsive and Related Disorders
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    • "Cognitive– behavioral therapy research has similarly examined the effect of session frequency on outcome and has found that in addition to affecting the amount of recovery, frequency may affect the speed of recovery. For example, in a comparison of obsessive– compulsive disorder treatment administered either daily (for 14 days) or weekly (for 14 weeks), therapeutic effects seemed to be equally effective, even at a 3-month follow-up (Storch et al., 2008; see also Emmelkamp, van Linden van den Heuvell, Rüphan, & Sanderman, 1989). If these two approaches are indeed equivalent in effect, the more frequent treatment facilitates a faster recovery for the patient. "
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    ABSTRACT: Objective: The dose-response relationship in psychotherapy has been examined extensively, but few studies have included session frequency as a component of psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical significance of this construct in a naturalistic setting, which is the aim of the current study. Method: Using an archival database of session-by-session Outcome Questionnaire 45 (OQ-45) measures over 17 years, change trajectories of 21,488 university counseling center clients (54.9% female, 85.0% White, mean age = 22.5) were examined using multilevel modeling, including session frequency at the occasion level. Of these clients, subgroups that attended therapy approximately weekly or fortnightly were compared to each other for differences in speed of recovery (using multilevel Cox regression) and clinically significant change (using multilevel logistic regression). Results: Results indicated that more frequent therapy was associated with steeper recovery curves (Cohen's f2 = 0.07; an effect size between small and medium). When comparing weekly and fortnightly groups, clinically significant gains were achieved faster for those attending weekly sessions; however, few significant differences were found between groups in total amount of change in therapy. Conclusions: Findings replicated previous session frequency literature and supported a clinically significant effect, where higher session frequency resulted in faster recovery. Session frequency appears to be an impactful component in delivering more efficient psychotherapy, and it is important to consider in individual treatment planning, institutional policy, and future research. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · Journal of Consulting and Clinical Psychology
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    • "In this study of 40 patients, intensive and weekly treatments were associated with equivalent decreases in the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS; m ¼15.7 and 15.6, respectively). Similarly, in the largest study of intensive OCD treatment to date, Storch et al. (2008) found that a similar percentage of adults no longer met the criteria for OCD following a 3-week intensive treatment, 40.7%, and weekly treatment, 52.3%. Despite the success of these intensive programs, a three-to fourweek treatment protocol places a considerable burden on families staying away from home. "
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    ABSTRACT: This study extends support for a 5-day intensive exposure and response prevention (ERP) treatment protocol for pediatric obsessive compulsive disorder (OCD). Twenty-two children with OCD received ERP treatment twice daily for 5 days. The treatment also emphasized teaching children and parents how to conduct ERP independently after they returned home. Symptoms were assessed at four time-points: Baseline, 4 weeks later at pre-treatment, one week after the intensive treatment 5-day treatment, and at 3 month follow-up. Changes on the primary outcome measure, clinician severity ratings on the Anxiety Disorders Interview Schedule for Children, and secondary measures, indicated that OCD symptoms remained stable from the evaluation to baseline and improved significantly from baseline to follow-up. Moreover, parental accommodation of OCD decreased significantly from baseline to post-treatment and from post-treatment to follow-up. These data suggest that the 5-day intervention demonstrates efficacy in reducing OCD symptoms and may initiate change in parent accommodation that continues to improve after the family returns home.
    Full-text · Article · Jul 2014 · Psychiatry Research
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