Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder

<b><i>Introduction:</i></b> Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has proven its efficacy in randomized controlled trials (RCTs). <b><i>Objective:</i></b> To test generalizability to routine care settings, we conducted an effectiveness study to provide naturalistic outcome data and their predictors. <b><i>Methods:</i></b> Pre-post changes in symptoms and impairment as well as response rates were determined in a naturalistic OCD sample (intention-to-treat, ITT, <i>n</i> = 393). Patients received individual CBT for OCD adopting an exposure-based, non-manualized treatment format. Linear and logistic regression analyses were applied to identify associations of sociodemographic and clinical variables with symptom change. <b><i>Results:</i></b> Effect size in ITT patients amounted to <i>d</i> = 1.47 in primary outcome (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS). Remission rates were 46.3% (ITT), 52.0% (completers), and 18.2% (non-completers). The rates of treatment response without remission, no change, and deterioration in the ITT sample were 13.2, 38, and 3%, respectively. Initial symptom severity, comorbid personality disorder, and unemployment were associated with a poorer outcome, and previous medication with a better outcome. Comorbid depressive and anxiety disorders as well as other clinical or sociodemographic variables showed no effects on symptom change. <b><i>Conclusions:</i></b> Outcomes in this large observational trial in a naturalistic setting correspond to available RCT findings suggesting that CBT for OCD should be strongly recommended for dissemination in routine care. Targets for further research include early prediction of non-response and development of alternative treatment strategies for patients who respond insufficiently.

An Evaluation of Cognitive Behavioral Therapy for Substance Use: An Application of Tolin’s Criteria for Empirically Supported Treatments

This document includes a formal evaluation of cognitive behavioral therapy for substance use disorder per the Tolin et al., (2015) criteria.

Parent-Child Autonomic Synchrony During Vicarious Extinction Learning in Pediatric PTSD

Children must learn basic functional processes directly from their caregivers and child psychopathology may disrupt this transmission. This transmission may be seen through biological measures like peripheral nervous system outputs like skin conductance (SCR). Fear learning deficits have been seen in affective disorders like PTSD and are useful for studying parent-child learning transmission. Our study uses a vicarious fear extinction paradigm to study if biological synchrony (SCR and heart rate variability (HRV)) are potential mechanisms in which children learn safety cues from their parents. There were 16 dyads (PTSD n=11, TD n=5) undergoing a vicarious fear extinction paradigm. We used cross-recurrence quantification analysis (CRQA) to assess SCR and HRV synchrony between parent-child dyads. We then used a linear model looking at group differences between PTSD dyads and typically developing (TD) dyads. For SCR, we saw a significant group difference (p=.037) indicating that TD dyads had higher SCR synchrony compared to PTSD dyads. For HRV, there were no group differences between PTSD and TD dyads (p=.325). These results suggest that SCR synchrony, but not HRV, may be a potential mechanism that allows for fear and safety learning in youth. While this is preliminary, it may give the first insights on how therapies such as Trauma-Focused Cognitive Behavioral Therapy critically rely on parental coaching to model appropriate fear responses to help their child to recover from trauma.