[Can the efficacy of behavioral and cognitive therapy for obsessive compulsive disorder be augmented by innovative computerized adjuvant?]
OBJECTIVE
Cognitive behavioral therapy (CBT) is recognized as an effective treatment for obsessive-compulsive disorder (OCD). To maximize its effectiveness, we designed an "experimental" CBT defined by the addition of a computerized psychoeducative tool.


METHODS
In a participative process involving patients through meetings of the French OCD association (AFTOC) and therapists through methodological workshops, we built a therapeutic tool from an experimental checking task. This task, which had been published in an earlier work, was adapted for its psychoeducative dimension. We here report on a randomized double-blind trial which included 35 patients with a moderate to severe OCD (Yale-Brown obsessive-compulsive scale, YBOCS between 16 and 25) predominant checking symptoms, no comorbidities, and 2-month stabilized or no treatment. Patients were randomly assigned to either "standard" versus "experimental" CBT. Both therapies were conducted by four CBT-experienced therapists specialized in OCD through weekly individualized sessions over 3 months. Therapy sessions of the experimental CBT were conducted as the standard CBT except for a short exercise with the computerized psychoeducative tool performed by the patient and debriefed with the therapist at the end of the sessions. Patients were assessed before, during, after therapy and again 6 months later using standard clinical tools and a neurobehavioral assessment based on an original symptom-provocation task with anxiety ratings including three types of photographs: neutral, generic inducing obsessions (e.g., doorknobs, electric wires…) and personalized (taken by the patients in their own environment).


RESULTS
Clinically, "standard" and "experimental" CBT resulted in a significant but equivalent improvement (48% vs 45% reduction of the Y-BOCS score; P=0.36; d=0.12). Therapists were satisfied with the psychoeducative dimension of the computerized psychoeducative tool but reported variable acceptance across patients. Patients appreciated its usability. The clinical improvement was associated with a reduction of the task-induced anxiety (r=0.42, P<0.05), especially towards personalized items (-28,2% vs -20.41% for generic and -6.24% for neutral photographs, P<0.001). Mid-therapy response level was predictive of the final improvement (r=0.82, P<0.001).


CONCLUSIONS
The computerized tool may provide a well-accepted therapeutic adjuvant even though it doesn't improve the therapeutic effect. Using a personalized symptom-provocation task reveals the parallel evolution of symptoms and neurobehavioral markers through CBT. Despite the difficulty of improving an evidence-based therapy, mid-therapy results call for investigating the possible adjustments of treatment strategies at an early stage.
Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France. Electronic address: margot.morgieve-mas@inserm.fr.
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Morgiève
Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France.
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N'Diaye
Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Clair
Fondation FondaMental, 94000 Créteil, France; Pôle de psychiatrie, UPEC, Inserm U955, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France.
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Pelissolo
Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France; Centre d'investigation clinique, CHU Pitié-Salpêtrière, 75013 Paris, France.
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Mallet
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
Clinical trial as topic; Cognitive behavioural therapy; Essais cliniques comme sujet; Innovation thérapeutique; Obsessive compulsive disorder; Outil informatisé; Software tools; Therapeutic research; Thérapie cognitive et comportementale; Trouble obsessionnel compulsif