Cognitive behavioral therapy in pharmacoresistant obsessive–compulsive disorder
Authors Vyskocilova J, Prasko J, Sipek J
Received 2 December 2015
Accepted for publication 29 December 2015
Published 14 March 2016 Volume 2016:12 Pages 625—639
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Xiang Mou
Peer reviewer comments 3
Editor who approved publication: Dr Roger Pinder
Jana Vyskocilova,1 Jan Prasko,2 Jiri Sipek3
1Faculty of Humanities, Charles University in Prague, Prague, 2Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 3Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic
Background: The aim of the study was to determine whether patients with obsessive–compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline.
Methods: Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale–Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale–Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period.
Results: During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder.
Keywords: obsessive–compulsive disorder, treatment, cognitive behavioral therapy, treatment resistance, treatment efficacy, predictors
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