Treating OCD

Treating OCD: the Effectiveness of Exposure and Response Prevention

Obsessive-compulsive disorder, commonly referred to as OCD, is an anxiety disorder diagnostically characterized by undesirable and invasive neurotic episodic thoughts or agonizing images.  Generally, such occurrences foster irrational behavior in an attempt to pacify or prevent the thoughts or circumstances associated therein (Butcher, Mineka, & Hooley, 2010).  In effort to further explicate this condition, a synopsis of an OCD treatment is provided hereafter regarding the purpose of the research, hypothesis, procedure, results and indications, strengths and weaknesses, and psychological value.

Within the article, Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder (2011), empirical research is presented concerning the treatment of OCD to evaluate the effectiveness of cognitive behavioral techniques.  In particular, the focus was exposure and response prevention (EX/RP).  Formerly, researchers proposed that more personalized care between sessions enhanced favorable results among OCD sufferers.  More specifically, patient adherence to facing fears and triggers (exposure) in conjunction to abstaining from avoiding such occurrences (response prevention) was considered to promote positive outcomes.  However, the effectiveness of EX/RP methods remained controversial (Simpson, Maher, Wang, Bao, Foa, & Franklin, 2011).  Arguably, “Woods, Chambless, and Steketee (2002) found no significant relationship between EX/RP outcome and patient homework adherence” (Simpson et al., 2011, p. 248).  Subsequently, it should be noted that the aforementioned studies utilized contrasting tools to assess patient adherence.  Issues concerning validity and reliability were prevalent as well.  Hence, researchers collaborated at the Anxiety Disorders Clinic at the New York State Psychiatric Institute, Columbia University, in an attempt to adequately determine the correlation of patient adherence to the effectiveness of treatment outcome in OCD patients.  More distinctively, they speculated that “patient adherence to between-session EX/RP assignments would be inversely associated with post-treatment OCD severity” (Simpson et al., 2011, p. 248).  In other words, as patients fulfill the suggested exercises, they lessen the probability of detrimental outcomes.

In order to test the hypothesis, 30 adults, between 18 and 70 years old, with OCD were considered and declared eligible based on a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).  Through a random selection process, they were separated into 2 groups, those to receive standard EX/RP and those to receive EX/RP in conjunction with motivational interviewing (MI) techniques (EX/RP + MI), each composed of 15 participants.  Each group adhered to traditional EX/RP regulations inclusive of 3 introductory sessions, weekly exposure sessions, and daily homework exercises.  However, as the variance between groups was deemed insignificant, participants of both groups were coalesced accordingly (Simpson et al., 2011).  Next, objective independent researchers evaluated participants prior to therapeutic sessions, then after completion of sessions 3, 11, and 18 in effort to calculate OCD severity, clinical response, and symptoms of depression.  Additionally, patient adherence was measured prior to exposure sessions 5-18 rating the amount of exposure, the quality of exposure, and the level of prevention (Simpson et al., 2011). 

Testing results indicated that 5 participants aborted the program between sessions 4 to 15.  Of the remaining 25 participants, 63.3% achieved a 25% reduction in OCD symptoms and the remaining 36.7% achieved and excellent resolve.  Hence, “patient adherence to between-session EX/RP assignments significantly predicted posttreatment OCD severity” (Simpson et al., 2011, p. 249).  The implementation of patient homework adherence had a direct positive affect to decrease OCD symptoms.  Therefore, practitioners should observe and evaluate patients’ conditions and practices in-between sessions.

In a constructive aspect, this research demonstrated the benefit of cognitive based techniques utilized to treat OCD.  Patients’ ability to adhere to EX/RP exercises directly correlated to their success in overcoming OCD symptoms.  However, although varied ages were represented, this is a sample of only thirty participants from the northeastern United States.  A more comprehensive assessment should be considered inclusive of a larger quantity of participants from varying regions and experiences in effort to establish broad conclusions.

These findings are of benefit to the field of psychology due to the fact that they offer insight to practitioners and hope to those afflicted with OCD.  Personally, it appears that a participant’s involvement in the therapeutic process increases the level of success in overcoming such transgressions.  In short, with these considerations, treating patients with OCD becomes more practical and attainable.   

As an apprentice in the field, this research offers guidance in the quest to assess and treat OCD.  The realization of an effective approach fosters a sense of assurance, encouraging one’s ability to offer support and assistance.  Often, implementing relative, tested information serves as an essential outline to coping with problematic issues and disorders.

In conclusion, attaining effective resolutions to abnormal psychological disorders is advantageous.  In particular, cognitive behavioral techniques are quite applicable to the treatment of such afflictions.  In respect to OCD, exposure and response prevention (EX/RP), cognitive-based practices, are beneficial means of lessening OCD severity.  Patients implementing these exercises enhance the ability to achieve favorable outcomes.  Thus, independent, personal involvement and recognition in concurrence to therapeutic sessions improve levels of normalcy and cognitive, inter-relational functioning in OCD cases (Simpson et al., 2011).  

References:

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Simpson, H.B., Maher, M.J., Wang, Y., Bao, Y., Foa, E.B., & Franklin, M. (2011).

            Patient adherence predicts outcome from cognitive behavioral therapy in

obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology,

79(2), 247-252.

Eating Disorder Treatment

Eating Disorder Treatment

            While researching the topic, eating disorders, I was somewhat astonished at the range of information.  Although this is a prevalent issue in modern society, I have never dealt with such issues first or second-hand.  Hence, I was in a sense oblivious to the quantity of treatment options available.  Traditionally, cognitive behavioral therapy (CBT) has been the foremost methodology of choice.  Also, when applicable, family therapy may be utilized, particularly in cases involving children.  Additionally, in conjunction to therapy, medication may be prescribed in order to help clients cope with depression (Butcher, Mineka, & Hooley, 2010).  However, innovative means of treating eating disorders are emerging.  With a growing populace of men and boys along with enhanced technology, diagnosis and treatment are evolving.  In effort to explicate such phenomena, the following reviews have been provided.

            To begin with, eating disorders such as bulimia nervosa and anorexia nervosa are often dealt with through the implementation of CBT.  A particular research article, What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders? (2012), utilized an empirical study conducted by the Loughborough University Ethics Committee (Institutional Review Board).  The committee examined 100 psychological therapists (85 women, 15 men) administering psychiatric aid to clients with eating disorders.  From these, 80 clinicians (69 women, 11 men) employing CBT techniques were designated.  Consequently, an online survey was conducted to inspect the frequency of such techniques.  The results indicate that although CBT practices were utilized approximately 50% of clinicians refrained from routinely designating a single technique.  Thus, no specific procedure was regularly employed.  Furthermore, traditional CBT methods were often used in conjunction with pre-therapy motivational tools.  Additionally, although most clinicians claim to utilize CBT, they implemented an assortment of applicable supplementary means as well.  Hence, “clinicians and patients should not assume that the use of the label CBT is clearly related to what clinicians do in practice” (Waller, Stringer, & Meyer, 2012, p. 174).  Researchers speculate that this occurrence is due to the fact that practitioners desire to maintain a pragmatic status for organizational or insurance purposes or practitioners are accustomed to the label and merely refrain from altering said label as their practice evolves (Waller et al., 2012).

            Another article, “Technology-Enhanced Maintenance of Treatment Gains in Eating Disorders: Efficacy of an Intervention Delivered via Text Messaging” (2012), considers the initial usage of CBT, yet examines the need for follow-up, second level interventions as well.  Often, pharmacological methods are employed at this stage.  However, in many instances clients fail to follow through with the medication.  Furthermore, therapeutic and medicinal methods in general are not cost efficient.  Therefore, this study focuses on the effectiveness of text messaging as an additional form of treatment to enhance and maintain favorable outcomes and prevent relapse. Researchers assessed 184 clients upon completion of 20 CBT sessions at AHG Psychosomatic Hospital Bad Pyrmont, Germany.  Of these, 19 were omitted for the following reasons: not meeting inclusion criteria (5), refusal to participate (10), or other reasons (4).  Next, the field of 165 were separated into a control group (83 participants), receiving no in-house secondary intervention, and the intervention group (82 participants), receiving SMS text messages.  The text messaging program required clients to utilize a standardized format to weekly report on 3 major bulimic symptoms, body dissatisfaction, frequency of binge eating, and frequency of compensatory behaviors over a period of 16 weeks.  Impairment levels and assessment modifications were observed.  Accordingly, research assistants provided suggestive CBT feedback in response.  It should be duly noted that 4 participants in the SMS intervention group did not send any texts and 11 others failed to follow-up after the second week, hence 71 active participants remained throughout the process.  In addition, nearly an equal number of participants in the control group (36) and the intervention group (38) independently sought outpatient treatment.  The most notable variance of the 2 groups was the rate of remission, indicating a decrease of bulimic symptoms or relapse.  Overall, participants in the intervention group which received outpatient care held a 63.2% remission rate as opposed to 55.6% of control group participants with outpatient care.  Additionally, 54.5% of the intervention group without outpatient care had a positive remission rate as opposed to only 30.3% of the control group without outpatient care.  Therefore, one may conclude that text messaging, particularly in conjunction with outpatient care, provides a greater likelihood of long term success among bulimic patients (Bauer, Okon, Meermann, & Kordy, 2012).

            Now, in consideration of an increased occurrence of men and boys plagued by eating disorders, researchers from the University of Iowa suggest gender-based therapy.  Often, diagnosing these disorders in males is challenging because males provide more feasible motives for dieting, physicians and society have biased views, and a variance exists among the admittance level between males and females.  Thus, gender-sensitive psychotherapies are implemented to address male socialization and control issues in relation to eating disorders (Greenberg & Schoen, 2008).

Additionally, internet-based interventions are utilized to treat such disorders.  As with the SMS text intervention, such methods are secondary, post-clinical treatment tools.  Internet-based programs provide self-help and prevention of relapse.  A specific program, EDINA (translated as Internet-based Aftercare for Patients with Eating Disorders) is utilized by Hungarian therapists.  In addition to the aforementioned provisions, this program offers peer support, professional consultation, symptom monitoring, supportive feedback, and group chat sessions.  Such amenities grant the patient the ability to maintain improvement, further recovery, and transition from treatment to everyday life (Gulec, Moessner, Mezei, Kohls, Tury, & Bauer, 2011).

References:

Bauer, S., Okon, E., Meermann, R. & Kordy, H. (2012). Technology-Enhanced

Maintenance of Treatment Gains in Eating Disorders: Efficacy of an Intervention

Delivered via Text Messaging. Journal of Consulting and Clinical Psychology,

80(4), 700-706.

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Greenberg, S. T. & Schoen, E. G. (2008). Males and eating disorders: Gender-based

therapy for eating disorder recovery. Professional Psychology: Research and Practice, 39(4), 464-471.

Gulec, H., Moessner, M., Mezei, A., Kohls, E., Tury, F., & Bauer, S. (2011). Internet

based maintenance treatment for patients with eating disorders. Professional

Psychology: Research and Practice, 42(6), 479-486.

Waller, G., Stringer, H., Meyer, C. (2012). What cognitive behavioral techniques do

therapists report using when delivering cognitive behavioral therapy for the eating

disorders? Journal of Consulting and Clinical Psychology, 80(1), 171-175.