When it's at: An examination of when cognitive change occurs during cognitive therapy for compulsive checking in obsessive-compulsive disorder

Abstract Background and objectives The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. Methods Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. Results Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. Limitations The small sample size limits our ability to generalize our results. Conclusions Results are discussed in terms of a focus on the timing of change in cognitive therapy

Targeting attachment in the cognitive behavioural therapy of obsessive compulsive disorder : using single case time series experiments to assess efficacy

Repeated time series single case experiments were used to test if attachment-related interventions added to the efficacy of cognitive behavioural therapy (CBT) for treatment-resistant obsessive compulsive disorder (OCD) in two insecurely attached individuals. We developed a method for formulating cases with respect to attachment, and delineating specific, attachment-related interventions. The baseline treatment phase consisted of standard CBT and the intervention phase featured the addition of attachment-related interventions. Clinically significant change was assessed using Jacobson's method, and times series data was analyzed using overfitted ARIMA modeling.Both participants improved symptomatically with standard CBT. Attachment-related interventions did not add to efficacy of symptom reduction, but did facilitate cognitive change, especially core beliefs about vulnerability, and reduced daily levels of anxiety in both participants. For resistant individuals with OCD, the targeting of attachment-related thoughts, behaviour and feelings in therapy may facilitate change---a finding consistent with hypothetical links between attachment insecurity, core views about one's vulnerability and predisposition to anxiety