Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures

Background: Process research aims to identify mediators of therapy which can help increase the efficacy and optimization of therapy. The present study examined the role of estimated social cost, perceived social self-efficacy and perceived emotional control as potential mediators in Cognitive Behaviour Therapy (CBT) and Exposure Therapy (EXP) in individuals with social anxiety disorder. Methods: Fifty adults with a primary diagnosis of social anxiety disorder (SAD) were recruited from a tertiary treatment center and randomly assigned to receive either CBT (N=25) or EXP (N=25).Levels of social anxiety, estimated social cost, perceived social self-efficacy, and perceived emotional control were assessed at the beginning of each session. Multilevel modeling was used to estimate the effects of the above variables on social anxiety and examine differences between the two groups. Results: Changes in perceived social self-efficacy and estimated social cost predicted changes in social anxiety. Perceived emotional control was not a significant predictor of changes in social anxiety. There were no significant differences between the two groups. Limitations: The study has a small sample size, and there is a lack of adequate follow-up data. A single therapist delivered both interventions, which could limit external validity. Conclusions: Perceived social self-efficacy and estimated social cost emerged as mediators of both CBT and EXP. The two interventions had common meditational pathways, and there was an interactive bi-directional relationship between social anxiety and the studied mediators

Treatments used for obsessive-compulsive disorder-An international perspective

© 2019 John Wiley & Sons, Ltd.OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.Peer reviewe

Clinical Advances in Obsessive Compulsive Disorder: A Position Statement by the International College of Obsessive Compulsive Spectrum Disorders

© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND - https://creativecommons.org/licenses/by-nc-nd/4.0/), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.Peer reviewe

Antidepressant effects of ketamine and ECT: a pilot comparison

Background: To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes. Methods: This assessor-blinded randomized control trial included 25 patients (either sex; 18–65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI). Results Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis of variance revealed that ECT patients showed significantly greater reduction in HDRS (group*time interaction effect; F = 4.79;