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Cited by 22Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Long-term stability of benefits of cognitive behavioral therapy for obsessive compulsive disorder depends on symptom remission during treatment

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Elsner, Björn, Wolfsberger, Frieder, Srp, Jessica, Windsheimer, Antonia, Becker, Laura, Jacobi, Tanja, Kathmann, Norbert, Reuter, Benedikt·2020·Clinical Psychology in Europe
DOI 10.32872/cpe.v2i1.2785PMC PMC9645482
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Abstract

Background: Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and may afford stable long-term improvements. It is not clear, however, how stability or symptom recurrence can be predicted at the time of termination of CBT. Method: In a 1-year follow-up intention-to-treat study with 120 OCD patients receiving individual CBT at a university outpatient unit, we investigated the predictive value of international consensus criteria for response only (Y-BOCS score reduction by at least 35%) and remission status (Y-BOCS score ≤ 12). Secondly, we applied receiver-operating characteristic (ROC) curves in order to find an optimal cut-off score to classify for deterioration and for sustained gains. Results: Response only at post-treatment increased the likelihood of deterioration at follow-up compared to remission at an odds ratio of 8.8. Moreover, ROC curves indicated that a post-treatment score of ≥ 13 differentiated optimally between patients with and without symptom deterioration at follow-up assessment. The optimal cut-off score to classify for any sustained gains (response, remission, or both) at follow-up relative to baseline was 12. Importantly, previous findings of generally high long-term symptom stability after treatment in OCD could be replicated. Conclusion: The findings highlight the clinical importance of reaching remission during CBT, and suggest that a recently published expert consensus for defining remission has high utility.

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Research works printed but not linked: 34

  1. Albert U. Marazziti D. Di Salvo G. Solia F. Rosso G. Maina G. (2018). A systematic review of evidence-based treatment strategies for obsessive-compulsive disorder resistant to first-line pharmacotherapy. Current Medicinal Chemistry, 25(41), 5647– 5661. 10.2174/0929867325666171222163645 29278206 · DOI · Paper page
  2. Anderson R. A. Rees C. S. (2007). Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: A controlled trial. Behaviour Research and Therapy, 45(1), 123– 137. 10.1016/j.brat.2006.01.016 16540080 · DOI · Paper page
  3. Bablas V. Yap K. Cunnington D. Swieca J. Greenwood K. M. (2016). Mindfulness-based stress reduction for restless legs syndrome: A proof of concept trial. Mindfulness, 7(2), 396– 408. 10.1007/s12671-015-0457-9 · DOI
  4. Barrett P. Healy-Farrell L. March J. S. (2004). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 46– 62. 10.1097/00004583-200401000-00014 14691360 · DOI
  5. Bolton D. Perrin S. (2008). Evaluation of exposure with response-prevention for obsessive compulsive disorder in childhood and adolescence. Journal of Behavior Therapy and Experimental Psychiatry, 39(1), 11– 22. 10.1016/j.jbtep.2006.11.002 17207457 · DOI
  6. Braga D. T. Cordioli A. V. Niederauer K. Manfro G. G. (2005). Cognitive-behavioral group therapy for obsessive-compulsive disorder: A 1-year follow-up. Acta Psychiatrica Scandinavica, 112(3), 180– 186. 10.1111/j.1600-0447.2005.00559.x 16095472 · DOI
  7. Braga D. T. Manfro G. G. Niederauer K. Cordioli A. V. (2010). Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: A two-year follow-up. Revista Brasileira de Psiquiatria, 32(2), 164– 168. 10.1590/S1516-44462010000200012 20658055 · DOI
  8. Cabedo E. Carrió C. Belloch A. (2018). Stability of treatment gains 10 years after cognitive behavioral therapy for obsessive-compulsive disorder: A study in routine clinical practice. International Journal of Cognitive Therapy, 11(1), 44– 57. 10.1007/s41811-018-0002-4 · DOI
  9. Denys D. van Megen H. J. van der Wee N. Westenberg H. G. (2004). A double-blind switch study of paroxetine and venlafaxine in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 65(1), 37– 43. 10.4088/JCP.v65n0106 14744166 · DOI
  10. Derogatis L. R. Melisaratos N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595– 605. 10.1017/S0033291700048017 6622612 · DOI · Paper page
  11. Falkenström F. Josefsson A. Berggren T. Holmqvist R. (2016). How much therapy is enough? Comparing dose-effect and good-enough models in two different settings. Psychotherapy, 53(1), 130– 139. 10.1037/pst0000039 26928273 · DOI
  12. Foa E. B. Huppert J. D. Leiberg S. Langner R. Kichic R. Hajcak G. Salkovskis P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485– 496. 10.1037/1040-3590.14.4.485 12501574 · DOI · Paper page
  13. Goodman W. K. Price L. H. Rasmussen S. A. Mazure C. Delgado P. Heninger G. R. Charney D. S. (1989 a). The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46(11), 1012– 1016. 10.1001/archpsyc.1989.01810110054008 2510699 · DOI · Paper page
  14. Goodman W. K. Price L. H. Rasmussen S. A. Mazure C. Fleischmann R. L. Hill C. L. Charney D. S. (1989 b). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006– 1011. 10.1001/archpsyc.1989.01810110048007 2684084 · DOI · Paper page
  15. Han X. Geffen S. Browning M. Kenardy J. Geffen G. (2011). Outcome evaluation of a multidisciplinary pain management programme comparing group with individual change measures. Clinical Psychologist, 15(3), 133– 138. 10.1111/j.1742-9552.2011.00032.x · DOI
  16. Hiller W. Schindler A. Andor T. Rist F. (2011). Vorschläge zur Evaluation regulärer Psychotherapien an Hochschulambulanzen im Sinne der Phase-IV-Therapieforschung. Zeitschrift für Klinische Psychologie und Psychotherapie, 40, 22– 32. 10.1026/1616-3443/a000063 · DOI
  17. Hohagen, F., Wahl-Kordon, A., Lotz-Rambaldi, W., & Muche-Borowski, C. (2014). S3-Leitlinie Zwangsstörungen. Berlin, Germany: Springer.
  18. Jacobson N. S. Truax P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12– 19. 10.1037/0022-006X.59.1.12 2002127 · DOI · Paper page
  19. Jones S. H. Thornicroft G. Coffey M. Dunn G. (1995). A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). The British Journal of Psychiatry, 166(5), 654– 659. 10.1192/bjp.166.5.654 7620753 · DOI
  20. Judd L. L. Akiskal H. S. Maser J. D. Zeller P. J. Endicott J. Coryell W. Keller M. B. (1998). Major depressive disorder: A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders, 50(2-3), 97– 108. 10.1016/S0165-0327(98)00138-4 9858069 · DOI · Paper page
  21. Kalanthroff E. Abramovitch A. Steinman S. A. Abramowitz J. S. Simpson H. B. (2016). The chicken or the egg: What drives OCD? Journal of Obsessive-Compulsive and Related Disorders, 11, 9– 12. 10.1016/j.jocrd.2016.07.005 · DOI
  22. Kraus D. R. Castonguay L. Boswell J. F. Nordberg S. S. Hayes J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapy Research, 21(3), 267– 276. 10.1080/10503307.2011.563249 21623550 · DOI
  23. Lampert, T., & Kroll, L. E. (2009). Die Messung des sozioökonomischen Status in sozialepidemiologischen Studien. In M. Richter & K. Hurrelmann (Eds.), Gesundheitliche Ungleichheit (pp. 309-334). 10.1007/978-3-531-91643-9_18 · DOI
  24. López-Ratón M. Rodríguez-Álvarez M. X. Cadarso-Suárez C. Gude-Sampedro F. (2014). OptimalCutpoints: An R package for selecting optimal cutpoints in diagnostic tests. Journal of Statistical Software, 61(8), 1– 36. 10.18637/jss.v061.i08 · DOI
  25. Lutz W. Wittmann W. W. Böhnke J. R. Rubel J. Steffanowski A. (2012). Zu den Ergebnissen des Modellprojektes der Techniker-Krankenkasse zum Qualitätsmonitoring in der ambulanten Psychotherapie aus Sicht des wissenschaftlichen Evaluationsteams. PPmP – Psychotherapie · Psychosomatik · Medizinische Psychologie, 62(11), 413- 417. 10.1055/s-0032-1327565 23152172 · DOI
  26. Moritz S. Meier B. Kloss M. Jacobsen D. Wein C. Fricke S. Hand I. (2002). Dimensional structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Psychiatry Research, 109(2), 193– 199. 10.1016/S0165-1781(02)00012-4 11927144 · DOI
  27. National Collaborating Centre for Mental Health. (2006). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder (National Clinical Practice Guideline Number 31). Leicester, United Kingdom: British Psychological Society and The Royal College of Psychiatrists. 21834191
  28. Pallanti S. Hollander E. Goodman W. K. (2004). A qualitative analysis of nonresponse: Management of treatment-refractory obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 65(Suppl 14), 6– 10. 15554782
  29. Paykel E. S. Ramana R. Cooper Z. Hayhurst H. Kerr J. Barocka A. (1995). Residual symptoms after partial remission: An important outcome in depression. Psychological Medicine, 25(6), 1171– 1180. 10.1017/S0033291700033146 8637947 · DOI · Paper page
  30. Robbins T. W. Gillan C. M. Smith D. G. de Wit S. Ersche K. D. (2012). Neurocognitive endophenotypes of impulsivity and compulsivity: Towards dimensional psychiatry. Trends in Cognitive Sciences, 16(1), 81– 91. 10.1016/j.tics.2011.11.009 22155014 · DOI · Paper page
  31. Rufer M. Hand I. Alsleben H. Braatz A. Ortmann J. Katenkamp B. Peter H. (2005). Long-term course and outcome of obsessive-compulsive patients after cognitive–behavioral therapy in combination with either fluvoxamine or placebo: A 7-year follow-up of a randomized double-blind trial. European Archives of Psychiatry and Clinical Neuroscience, 255(2), 121– 128. 10.1007/s00406-004-0544-8 15812606 · DOI
  32. Salkovskis P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37(Suppl 1), S29– S52. 10.1016/S0005-7967(99)00049-2 10402695 · DOI · Paper page
  33. Van Ameringen M. Allgulander C. Bandelow B. Greist J. H. Hollander E. Montgomery S. A. Swinson R. P. (2003). WCA recommendations for the long-term treatment of social phobia. CNS Spectrums, 8(8, Suppl. 1), 40– 52. 10.1017/S1092852900006933 14767397 · DOI
  34. Youden W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32– 35. 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3 15405679 · DOI

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Authors
Elsner, B., Wolfsberger, F., Srp, J., Windsheimer, A., Becker, L., Jacobi, T., Kathmann, N., & Reuter, B.
Affiliations
Humboldt-Universität zu Berlin (DE)
Corresponding author
Elsner, Björn
ORCID
Venue
Clinical Psychology in Europe
Publisher
Leibniz Institute for Psychology (ZPID)
Published
2020-03-31
Volume
2
Issue
1
Pages
e2785-e2785
ISSN
2625-3410 (ISSN-L)
DOI
10.32872/cpe.v2i1.2785
PMC
PMC9645482
OpenAlex
W3014461628
Cited by
22
References
10
Citations by year
2026: 2 · 2025: 4 · 2024: 7 · 2022: 4 · 2021: 5
FWCI
0.90
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Clinical Psychology in Europe (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe’s Journal of Psychology (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • PsychOpen Gold (Leibniz Institute for Psychology) (submittedVersion, cc-by)
  • Psychology Archives (cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, cognitive behavioral therapy, symptom remission, treatment response, symptom recurrence, long-term treatment stability, Yale-Brown Obsessive Compulsive Scale, remission criteria, cut-off values

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