Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder

Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD. Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up. Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1–7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up. Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD.publishedVersio

Psykologer ved fastlegesentra: Fastlegers syn på et tettere samarbeid

Tema: Opptrappingsplanen for psykisk helse og Samhandlingsrefomen har bidratt til en dreining i psykisk helsetjenester fra spesialisthelsetjenestenivå til primærhelsenivå. Målet var å sikre at pasientene skulle få et mer helhetlig behandlingstilbud nærmere der de bor, tidligere i sykdomsutviklingen. Evalueringen tyder på at mye er bedre, men at det fremdeles gjenstår en god del, særlig i forhold til pasienter med lettere angstlidelser og depresjon og i forhold til ventetider og fristbrudd. En av ordningene som er under utprøving i dag for å bedre på dette er psykologer samlokalisert på fastlegesentra. Problemstilling: Ønsker fastleger et tettere samarbeid med psykologer? Hvilken nytte, konflikter og utfordringer ser de i forhold til et slikt samarbeid? Hvilken trygghet opplever fastlegene for diagnostisering, behandling og henvisning av psykiske lidelser? Utvalg: Et tilfeldig utvalg av fastleger basert på fastlegelisten, hvor det er tatt høyde for ulikt antall fastleger i de forskjellige fylkene. Det var 300 i utvalget med en svarprosent på 28. Selv om utvalget er lite, har det samme karakteristika som populasjonen. Forskningsmetode: Surveyundersøkelse distribuert elektronisk og med posten. Hovedfunn: 86 % av fastlegene i studien ønsker et tettere samarbeid med psykologer(halvparten ønsker dette i stor grad). Særlig ønsker de samarbeid med psykologiske oppgaver for kompliserte psykiske lidelser, men også i forhold til psykosomatisk utredning og depresjon og angstlidelser. Det kommer ikke frem noen vesentlige problemer med et tettere samarbeid. Det er stor variasjon i den opplevde tryggheten i forhold til diagnostisering og behandling av psykiske lidelser. Det er grunn til å tro at dette i noen grad reflekterer en varierende kompetanse. Undersøkelsen viser at det er klima for samlokaliserte psykologer ved fastlegesentra. En nærmere evaluering av det pågående prøveprosjektet vil være viktig for å undersøke de praktiske erfaringene med allmennhelsesentra der psykisk og somatisk helse likestilles

The role of metacognition and obsessive-compulsive symptoms in psychosis: An analogue study

Background Several studies have indicated that obsessive-compulsive disorder (OCD) is a common comorbidity in patients with psychotic disorders, but there is sparse knowledge about the relationship between symptoms of OCD and psychotic symptoms. Metacognitions which guides thinking and coping is theorized to be a transdiagnostic component central for development and maintenance of psychological disorders, OCD and psychosis included. The aim of the study was therefore to explore how symptoms of OCD and metacognitions relate to symptoms of psychosis. Our main hypotheses were that metacognitions would be significantly related to all symptoms of psychological distress, and that there is considerable overlap between symptoms of psychosis and OCD. Methods: Community controls (N = 194) completed an internet survey measuring levels of paranoid ideation, predisposition to hallucinations, symptoms of OCD, depression, anxiety, and metacognitions. Correlations and hierarchical multiple linear regression analyses were used to unveil the relationship between symptoms and beliefs. Results: Symptoms of OCD showed a strong positive correlation with symptoms of psychosis, and the relationships were still significant after controlling for symptoms of anxiety and depression. Metacognitions also showed strong positive correlations with all symptom measures. Metacognition and OCD-symptoms accounted for 53.8% of the variance in paranoid ideation and 43.8% of predisposition to hallucinations. There was a large overlap between symptoms of psychosis, OCD-symptoms, and metacognitions (30.2–37.3%). Conclusions: In general, the results suggest considerable overlap between paranoid ideation, predisposition to hallucinations, and OCD and metacognitive beliefs in a non-clinical sample. Further experimental- and clinical studies are needed in order to explore metacognitive models of OCD and psychosis

Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder

Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD. Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up. Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1–7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up. Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD

Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder

Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD. Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up. Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1–7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up. Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD

Therapist variability in the task/goal dimension of the early working alliance predicts outcome in exposure and response prevention treatment for Obsessive-Compulsive Disorder

publishedVersio