An individual who had been diagnosed with Obsessive Compulsive Disorder (OCD) and Schizoaffective Disorder requested assistance with improving his ability to manage symptoms. He had a history of long-term hospitalizations that impacted his placements in residential facilities. He was treated using exposure and response prevention procedures applied to specific rituals pertaining to compulsive bed making, organization, excessive emptying of vacuum canister, excessive hand washing and excessive laundering of clothing. A baseline was established for each ritual by the experimenter exposing the subject to the conditions that "triggered" the rituals. The latency was measured between the presentation of those conditions and the onset of the ritual. During treatment, the subject initiated the same conditions and then refrained from engaging in his rituals for a specific amount of time. Initially, the requested time was the average amount of time he was able to refrain from ritualizing in the baseline sessions. Then, the subject initiated exposure and refrained from the ritual for an increasing amount of time until he was able to refrain for 15 minutes or longer for three ritualistic behaviors. A multiple baseline analysis across rituals indicated that during the course of treatment, over a period of about 4 months, his ability to tolerate the triggers for his rituals was increased to the point that he did not engage in the rituals during the sessions.

Obsessive-compulsive disorder (OCD) is relatively common (Ruscio, Stein, Chiu, & Kessler, 2010) and leads to significant functional impairment (World Health Organization, 2001). Research suggests that exposure and response prevention (EX/RP) is efficacious for reducing OCD symptoms (NICE, 2006); however, standard outpatient EX/RP does not effectively alleviate symptom severity among a substantial proportion of OCD patients (Abramowitz, 2006). Intensive EX/RP programs have been developed to address the needs of treatment-refractory OCD patients (Veale et al., 2016). While evidence from effectiveness studies suggests that intensive EX/RP programs lead to significant reductions in OCD symptom severity, a portion of patients do not demonstrate improvement in response to intensive treatment (e.g., Björgvinsson, Hart, et al., 2013; Boschen, Drummond, & Pillay, 2008). These findings underscore the need to identify reliable predictors of OCD patient response to intensive EX/RP to help target clinical and research efforts toward improving treatment outcomes for those least likely to respond to current treatment modalities. Therefore, the proposed study evaluated distinct trajectories of OCD symptom change across six-weeks of intensive treatment and examined factors that predict membership in those trajectory groups. Results suggested that three latent subgroups of OCD patients emerged with one demonstrating symptom relapse during intensive treatment. Further, OCD symptom severity was the only baseline factor that predicted latent-class membership. Implications and future directions of research are discussed.

The need for effective treatments and treatment accessibility for obsessive-compulsive disorder (OCD) in childhood is evident given that as many as 50% of individuals with OCD report symptom onset before age 15. Despite the growing evidence supporting the efficacy of Exposure and Response Prevention (ERP) for youth with OCD, children seeking services for their OCD symptoms often do not receive ERP. Intensive treatment programs may be a feasible treatment option for children and their families who do not have access to ERP treatment and/or live in an area where therapists trained in ERP are limited. Preliminary studies have shown initial promise for 5-day intensive treatment programs, which have collapsed one-month intensive programs into an even shorter duration. This study serves as the first controlled, one-week intensive intervention for pediatric OCD. To evaluate the efficacy, feasibility, and acceptability of this brief, one-week intensive ERP program for pediatric OCD, nine children with OCD were randomized to a one-week, two-week, or three-week baseline period in a single-case, non-concurrent multiple baseline experimental design. Although symptoms were relatively stable during the baseline period, most participants showed reductions in OCD symptoms with the implementation of treatment. Treatment gains were maintained at a 3-month follow-up assessment; 67% of children were considered treatment responders. Children and families perceived the program to be acceptable, feasible, and beneficial. This study provides support for the efficacy and feasibility of a 5-day intensive treatment program for pediatric OCD. / Ph. D.

The aim of the present study was to examine the prevalence of eating disorder symptoms in patients with obsessive-compulsive disorder (OCD). Additional aims were to assess whether having comorbid eating disorders could influence the treatment outcome for OCD, and if symptoms of eating disorders were reduced after treatment for OCD. The sample consisted of 93 patients with a primary diagnosis of OCD. The patients underwent assessment with the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, and Eating Disorder Inventory both prior to and after treatment. First, the analysis showed that the sample of OCD patients had higher prevalence of eating disorders than a population of physically active students. Moreover, the women in the sample had significantly more symptoms of eating disorders than the men. Correlational analysis showed that eating disorders did not affect the treatment outcome for OCD; the patients generally had a significant improvement of OCD symptoms. On the other hand, symptoms of eating disorders were not significantly reduced after treatment. Summarized, this study concludes that there is a high prevalence of eating disorder symptoms among patients with OCD. It further shows that comorbid eating disorders does not hinder the effect of treatment for OCD. However, as the symptoms of eating disorders persist after such treatment, an implication of the present study is that these symptoms may need closer attention.

No description available.

ERP larp is a live-action role-play game designed to make exposure and response prevention therapy for people who have obsessive compulsive disorder more accessible. Although it is not meant to substitute therapy, it is a self-help guidance that can be applied at home. The research and design combine studies regarding OCD, game design core loops, and larp studies and is an experimental game design. In-depth interviews, quantitative data from the playtester and autobiographic observations are applied to assess its effect on the playtester. The analysis demonstrates that ERP larp is successful in lowering the effect of OCD on the playtester by lowering their anxiety and improving their sense of agency / control. However, the results are not conclusive. It is a pilot study conducted with one playtester and as only two playtest sessions were conducted and data shows that the changes are not substantial. Future research and additional playtests are required to develop and assess the efficacy of ERP larp.

D-cycloserine (DCS), a partial agonist that acts on the N-methyl-D-aspartate (NMDA) receptor of the glutamatergic receptor complex, may enhance fear extinction learning during exposure-based therapy. Clinical studies in adults with obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders - and a recent trial in pediatric OCD - have shown that DCS can improve treatment response to exposure therapy relative to placebo and exposure therapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS and homework compliance in a 10-week, double-blind, placebo controlled DCS+CBT treatment trial with 30 children and adolescents with a primary diagnosis of OCD. D-cycloserine was dosed 25 or 50mg (depending on weight) one hour before therapy sessions 4-10. Group status (DCS or placebo) did not predict improved homework compliance over the course of treatment. However, significant group differences in homework compliance were found at the first exposure session. Additionally, homework compliance mediated the relationship between DCS and treatment outcome. When groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that outside the context of DCS, homework compliance is an integral part of OCD treatment.

Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption thatmetacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.

Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients’ ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.