[A standardized cognitive-behavioural group treatment program for obsessive compulsive disorder: preliminary outcomes].
This study provides preliminary outcome data about the efficacy of a cognitive behavioural group therapy program for obsessive compulsive disorder (OCD). Twenty patients were studied, 19 completed the group and one dropped out (5%), Twelve patients were evaluated at 6 month follow-up (40% of drop-outs). All were outpatients who received a primary DSM IV diagnosis of OCD. All evaluations were performed before and after the beginning of the group. Evaluations involved: 1) one or more face-to-face interviews, 2) scales or questionnaires which are designed to provide information relevant to anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), OCD symptoms (YBOCS, four target rituals and four target obsessions) and OCD cognitive measures (Obsessive Beliefs Questionnaire: OBQ). The patients completed a 12-week closed-ended treatment program. The group meets once a week for 3 hours. The first 6 sessions included cognitive therapy and the 6 other sessions focused on behaviour therapy. During the first session of each technique, workbooks are provided and discussed with the patients. During the cognitive treatment of the weekly group, patients apply the cognitive therapy of Salkovskis during the sessions and at home. The therapy focused on challenging OCD appraisals and beliefs through various cognitive techniques. During the 6 last sessions explanations of behavioural therapy techniques are done then the patients practiced in vivo and imaginal exposures and response prevention. Morever, each patient received an exposure homework practice. Then six monthly meeting dates are scheduled and patients are encouraged to carry on homeworks. The sample included 12 women and 8 men and the mean age at intake was 37 (SD=9.33) years. Eighteen of the patients were taking medication for their OCD symptoms before and concurrent with group participation. The sample had a mean education of 15 (SD=3) years. Average symptom duration was 14 (SD=9) years. Significant reduction in YBOCS and obsessive beliefs (OBQ) were observed for subjects following treatment. A repeated measure analysis of variance failed to find a significant difference at post-test in Beck Depression and Anxiety Inventories. On main targets (four target rituals and four target obsessions) of the therapy, there was a change after the introduction of the cognitive therapy. There was no change between the cognitive therapy and the behaviour therapy. The difference was only maintained after the complete program. Extending the duration of the group to behaviour therapy did not enhance eventual outcomes. Clinical impressions suggested that behaviour therapy helped to maintain the results in the long term. The present study also demonstrated that most patients maintained gains made during the group at 6-month follow-up. Maintenance of gains was apparent for both the YBOCS and target symptoms (rituals and obsessions). However, there was no change in depression. At pre-test, the OCD patients had a mean score of 18, which is a mild level. Interestingly, there was a significant difference at 6 months in the Beck Anxiety Inventory. The anxiety level needed more time to decrease than OCD symptoms. Cognitive and behaviour therapy delivered in group was effective in decreasing OCD symptom severity and produced a decrease in all but one of the cognitive measures, the estimation of the threat. The result obtained at the end of the therapy was not sufficient at the follow up. This belief was common in all the anxiety disorders and was not specific of OCD. This clinical study is the first report of a cognitive and behavioural group program for OCD. Despite the limitations of this study, it demonstrates the utility of cognitive behaviour group therapy as an effective and efficient treatment of OCD.
Bouvard
M
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Unité de traitement de l'anxiété, Hôpital Neurologique, 59, boulevard Pinel, 69003, Lyon cedex 03, France.
D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D015397:Program Evaluation; D011795:Surveys and Questionnaires