Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study

Background: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. Methods: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. Results: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. Conclusions: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach

Stationäre Behandlung depressiver Erkrankungen wohnortnah oder wohnortfern: Gibt es Unterschiede im Therapieergebnis?

Background: Advantages and disadvantages of inpatient treatment for mental disorders in facilities located either close to or distant from the patients' homes have been controversially discussed since the Psychiatry Enquiry. However, the question whether the distance between residence and clinic influences the treatment outcome has so far only been examined in substance-dependent patients in residential medical rehabilitation. Therefore, in the present study, we aimed to investigate potential effects of the distance between residence and clinic on the treatment outcome in depressive patients. Patients and Methods: For this purpose, routine data of 1,959 clinically depressed inpatients were analyzed. Using the Patient Health Questionnaire, depression, anxiety, and somatization were assessed at admission, discharge, and the 6-month follow-up to analyze the treatment outcome. Results: The findings demonstrate that the distance between the residence and the treatment facility does not moderate depressive, anxious, and somatoform symptom changes during and after treatment. Moreover, the distance between clinic and residence and the symptom improvement from admission until follow-up do not correlate significantly. Conclusions: Hence, there is no empirical evidence showing that the distance between the residence and the treatment facility influences the treatment outcome. Therefore, future research should focus on the impact of specific treatment qualities close to or far away from home, like the facility's degree of specialization and the implementation of individualized aftercare

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study

Background: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. Methods: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. Results: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. Conclusions: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach

Common change factors and mediation of the alliance–outcome link during treatment of depression.

Objective: Alliance, Mastery/Self-Efficacy, Problem Actualization, and Problem Clarification exemplify common or nonspecific factors of change in psychotherapy (Grawe, 1997). In this study, we tested the hypothesis that other change factors mediate the alliance-outcome link on a within-person level over the treatment course. Method: Our sample consisted of 193 patients with major depression undergoing intensive inpatient cognitive-behavioral-based therapy. Each week, we assessed depressive symptoms (using the Beck Depression Inventory-II) and change factors during individual therapy. Multilevel mediation models were used to test our hypothesis. Results: As expected, within-person change in Alliance (differentiated into Emotional Bond and Contentment with the Therapist) as well as Mastery/Self-Efficacy and Problem Clarification predicted symptom change over the course of therapy. Moreover, the relation between Contentment with the Therapist and subsequent change in depression was mediated by increased Mastery/Self-Efficacy on a within-person level. Conclusions: Our data suggest that within-person change of alliance and other general change factors precede symptom change in depressive patients, and that the link between alliance and outcome may be partially mediated by enhanced Mastery/Self-Efficacy. Future studies should further elucidate the mechanisms responsible for the alliance-outcome link

Emotion regulation strategies in bulimia nervosa: an experimental investigation of mindfulness, self-compassion, and cognitive restructuring

Background While improving emotion regulation (ER) is a central goal in the therapy of bulimia nervosa (BN), there is no experimental evidence on the efficacy of different ER strategies. (1) We hypothesized that mindfulness as well as self-compassion as contextual strategies and cognitive restructuring as classical cognitive behavioral strategy would outperform waiting in improving emotional and eating disorder related outcomes after an unpleasant mood induction. Further, we explored (2) whether contextual strategies outperformed cognitive restructuring and (3) whether comorbid mental disorders and previous treatment for BN influenced the efficacy of contextual ER strategies compared to cognitive restructuring. Methods Within their first 2 weeks of treatment, inpatients with BN were instructed to utilize mindfulness, self-compassion, and cognitive restructuring or to wait after a pre-induced sadness in a permuted repeated measures design. Patients further rated different emotional and cognitive outcomes on a visual analogue scale at baseline, and before and after each ER strategy. Multiple linear regression analyses were employed to compare (1) the active conditions to waiting, (2) the contextual strategies with cognitive restructuring, and (3) the latter analysis again, but separated according to comorbidity and previous treatment. Results Forty-eight female inpatients with BN (mean age = 26.44 years, SD = 6.64) completed the study. (1) Contextual ER strategies were more efficacious than waiting for eating disorder symptoms. Cognitive restructuring did not differ from waiting for any outcome. (2) Contextual strategies were more efficacious than cognitive restructuring for emotional outcomes. (3) Self-compassion was more efficacious than cognitive restructuring in patients with comorbid mental disorders and previous treatment in increasing control over the present feeling. Conclusions Contextual strategies, especially self-compassion, seem more efficacious than waiting and cognitive restructuring in improving short-term ER in patients with BN in an experimental setting