Treatment of Obsessive Compulsive Disorder and excessive reassurance seeking in an older adult: a single case quasi-experimental design

Background: Cognitive behavioural interventions for excessive reassurance seeking (ERS) typically focus on encouraging individuals to refrain from seeking any reassurance and in some cases banning caregivers (e.g. family members) from providing it. However, this blanket consideration that reassurance is a bad thing that should simply be stopped may not always be appropriate or helpful. Cognitive behavioural treatment (CBT) targeting ERS by helping the sufferer to shift from seeking reassurance to seeking support may be a promising treatment intervention. Aims: This study aims to examine the targeted treatment of ERS in an older adult who has been suffering from severe obsessive compulsive disorder (OCD) for seven decades. Method: Using a single case quasi-experimental design (ABCD), the frequency of reassurance seeking, urges to seek reassurance, OCD beliefs and anxiety were measured daily for almost a year in addition to standard symptom measures. Results: At the end of treatment, visual inspection showed that reassurance seeking was no longer considered excessive and OCD severity fell from the severe to non-clinical range across the treatment sessions. All treatment gains were maintained at follow-up. Conclusions: This study illustrates how CBT can be successfully applied to treat long-standing OCD and ERS in an older adult. Engendering support as an alternative to reassurance seeking in CBT may be a particularly promising intervention for ERS.Aims: This study aims to examine the targeted treatment of ERS in an older adult who has been suffering from severe Obsessive Compulsive Disorder (OCD) for seven decades Method: Using a single case quasi-experimental design (ABCD), the frequency of reassurance seeking, urges to seek reassurance, OCD beliefs and anxiety were measured daily for almost a year in addition to standard symptom measures. Results: At the end of treatment, visual inspection showed that reassurance seeking was no longer considered excessive and OCD severity fell from the severe to non-clinical range across the treatment sessions. All treatment gains were maintained at follow-up. Conclusions: This study illustrates how CBT can be successfully applied to treat long standing OCD and ERS in an older adult. Engendering support as an alternative to reassurance seeking in CBT may be a particularly promising intervention for ERS

Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function

Excessive reassurance seeking (ERS) is commonly reported in patients who have OCD or health anxiety. Despite its prevalence and associated risk of ongoing difficulties, little is known about the function of ERS. It has been conceptualised as a type of compulsive checking behaviour, but could also be seen as being a supportive maneuver. This study offers a new approach towards defining ERS and support seeking (SS), and similarities between these two constructs in a sample of OCD and health anxious patients. A semi-structured interview was employed. Participants reflected on the nature and goals of their reassurance and support seeking—its impact on themselves and other people. Twenty interviews were conducted, transcribed and analysed in accordance to framework thematic analysis. Six overarching themes were identified in terms of ERS and five for SS. Results revealed limited diagnosis specificity of ERS. Strikingly, participants with health anxiety did not report seeking support

A randomised controlled trial of cognitive behavioural treatment for obsessive compulsive disorder in children and adolescents

Cognitive behaviour therapy (CBT) for young people with obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with OCD in typical outpatient settings

The Impact of Health Anxiety in Multiple Sclerosis:A Replication and Treatment Case Series

Background: Multiple sclerosis (MS) is commonly associated with psychological complications. Previous research by Hayter and colleagues (2016) found that in patients with MS, health anxiety (HA) can account for part of the variance in quality of life (QoL) independent of physical and cognitive impairment caused by the disease. MS patients with HA perceived their intact physical and cognitive performance as impaired relative to those without HA and attributed the impairment to MS. These misperceptions might be useful targets in the treatment of HA in MS using cognitive behaviour therapy (CBT). Aims: Study 1 sought to replicate the main findings from Hayter et al. (2016). Study 2 examined the impact of HA-focused CBT in a case series. Method: In Study 1, twenty participants with MS were screened for HA and assigned to either a high or low HA group. They completed assessments of cognitive and physical functioning before rating their performance on these tasks, followed by measures of QoL, mood and physical disability. Four participants in the high HA group subsequently received six sessions of CBT using a consecutive AB case series in Study 2. Results: Study 1 replicated the main findings from the earlier study. In Study 2, three of the four patients who received treatment showed substantial improvements in HA and mood and all showed improvement in QoL. Conclusion: Given the high rates of HA in MS patients and its impact on QoL, this case series suggests that a brief CBT intervention could significantly improve patients’ wellbeing.</p

The effectiveness and feasibility of psychological interventions for populations under ongoing threat: a systematic review

Current views of psychological therapies for trauma typically assume the traumatic event to be in the past. Yet, individuals who live in contexts of ongoing organized violence or experience intimate partner violence (IPV) may continue to be (re)exposed to related traumatic events or have realistic fears of their recurrence. This systematic review considers the effectiveness, feasibility, and adaptations of psychological interventions for individuals living with ongoing threat. PsychINFO, MEDLINE, and EMBASE were searched for articles that examined psychological interventions in contexts of ongoing threat of either IPV or organized violence and used trauma-related outcome measures. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on study population, ongoing threat setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Mixed-Method Appraisal Tool. Eighteen papers featuring 15 trials were included (12 on organized violence and 3 on IPV). For organized violence, most studies showed moderate to large effects in reducing trauma-related symptoms when compared to waitlists. For IPV, findings were varied. Most studies made adaptations related to culture and ongoing threat and found that providing psychological interventions was feasible. The findings, albeit preliminary with mixed methodological quality, showed psychological treatments can be beneficial and should not be withheld in the context of ongoing organized violence and IPV. Clinical and research recommendations are discussed

The Termination of Checking and the Role of Just Right Feelings:A Study of Obsessional Checkers Compared with Anxious and Non-clinical Controls

Background: Repeated checking in OCD can be understood from a cognitiveperspective as the motivated need to achieve certainty about the outcome of apotentially risky action, leading to the application of Elevated Evidence Requirements (EER) and overuse of subjective criteria. Method: Twenty-four obsessional checkers, 22 anxious controls, and 26 non-clinical controls were interviewed about and rated recent episodes where they felt (a) they needed to check and (b) checked mainly out of habit (i.e. not obsessionally). Results: Both subjective and objective criteria were rated as significantly more important in obsessional checkers than in controls; obsessional checkers also used more criteria overall for the termination of the check, and rated more criteria as “extremely important” than the control groups. The termination of the check was rated as more effortful for obsessional checkers than for the comparison groups. Analysis of the interview data was consistent with the ratings. Feelings of “rightness” were associated with the termination of a check for obsessional checkers but not for controls. Conclusion: Results were consistent withthe proposal that the use of “just right feelings” to terminate checking are related to EER

I do not know what else to do: caregivers’ perspective on reassurance seeking in OCD

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behavior that resembles the compulsive behaviors that are typically seen in OCD. ERS can be complex, persistent, extensive, debilitating and may dominate people’s interactions. In addition to resembling compulsive checking in OCD it may also have the effect of transferring responsibility to others. Caregivers are frequently asked to take part in a range of rituals as part of the OCD sufferer’s problem, often seeing it as a way of supporting the sufferer. We are still in the early stages of understanding the factors that elicit and maintain these responses in caregivers. The present investigation considered the interpersonal components of ERS by applying an in-depth analysis using qualitative methods in the context of an interview of caregivers who provide reassurance to OCD sufferers. Ten interviews were conducted and analysed using thematic analysis. Seven overarching themes were identified as important in the experience of being asked for and providing reassurance. These concern factors such as how people seek reassurance, how they process it, why other people give it and so on. A particularly pervasive theme was caregivers’ experience of frustration in the face of ERS. Clinical implications of the findings are discussed

Utilising patient and public involvement to increase the acceptability of brief CBT for OCD in young people

Obsessive Compulsive Disorder (OCD) is a common and debilitating disorder that frequently begins in childhood and adolescence. Previous work (Bolton et al., 2011) has demonstrated that brief CBT (5 sessions), supplemented by therapeutic workbooks, is as effective as more traditional length (12 session) therapist-delivered treatment for adolescents with OCD. However, as was typical at the time, the treatment was developed with very limited patient and public involvement (PPI) and was delivered in the context of a randomised controlled trial which might affect translation to routine child and adolescent mental health services (CAMHS). To be able to implement such treatment within routine clinical services, it is crucial that it acceptable to young people, their families and the clinicians delivering the treatment. The aim of this project was to improve the acceptability of the brief treatment through PPI and consultation with clinicians and consider issues relating to implementation. This was done through written feedback, interviews and focus groups with five adolescents and two parents, and a focus group and a half-day workshop with 12 clinicians. This led to revisions to the workbooks and materials to improve (a) acceptability by updating the design through changes to wording, language, and images and to ensure that they were consistent with values of equality, diversity, and inclusion, and (b) usability by clarifying, adding, removing content, and organising the materials in new ways. We emphasise the importance of continued PPI throughout the project to maximise the translation of findings into practice

Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study

Background: Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use. Aim: To explore the feasibility and acceptability of cognitive-behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost-effectiveness. Design and Setting: A CBT case series was carried out in five GP practices. Method: Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments. Results: Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over median three months. Twenty-four (75%) attended > 6 sessions. Eighteen FAs (86%, n=21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (55%, n=24) achieved clinically important improvement on the SF-36 Mental-Component Scale at six month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from median eight contacts in three months at baseline (n=32) to three contacts in three months at one year (n=18). Conclusion: CBT appears feasible and acceptable to a sub-set of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach might contribute to decreasing GP workload and merits larger-scale evaluation

Acknowledging religion in cognitive behavioural therapy: the effect on alliance, treatment expectations and credibility in a video-vignette study

Objectives: Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims. Methods: A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. Results: One hundred twenty-nine British Muslim adults aged 18–70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the ‘therapist’, but that acknowledging religion did not impact upon anticipated alliance. Conclusions: These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups