Week 6 RF-Improving outcomes for OCD Flashcards
What are the Stages in Developing a New Psychological Treatment? Medical Research Council Framework (2019)
- Is there a need for a new/better/more efficacious treatment? How do you decide?
- Is there a coherent theory that underpins the treatment? How do we test the theory? What constitutes “good” evidence?
- Stages of treatment evaluation; single case series, open trials, feasibility studies, randomised controlled trials, effectiveness studies
What aspects are involved in obsession and compulsions in OCD?
Obsessions:
-Recurrent & persistent thoughts, images or urges that are experienced as intrusive and unwanted and cause marked anxiety or distress.
Compulsions:
-Repetitive behaviours (e.g. hand washing, checking) or mental acts (e.g. praying, counting) that the person feels driven to perform in response to an obsession to reduce distress or preventing some dreaded event or situation.
Are Advances in Treating OCD Required?
-CBT or ERP - recommended psychological approaches for OCD (NICE, 2006)
-Multiple meta-analyses conclude that CBT or ERP are effective interventions (Abramowitz et al., 2002; Eddy et al., 2004; Gava et al., 2007; Jónsson and Hougaard, 2009; Olatunji et al., 2013; Öst et al., 2015; Pearcy et al., 2016; Romanelli et al., 2014; Rosa-Alcázar et al., 2008; Schwartze et al., 2016; Skapinakis et al., 2016; Wootton, 2016).
-Meta-analyses focused on statistical significance (effect sizes) not the clinical significance
-We need to know if psychological interventions produce clinically meaningful change
What was the method for Fisher et al’s (2020) study on a clinical significance of psychological interventions for OCD?
-To determine the efficacy treatment for OCD
-Applied Jacobson criteria to individual patient data on the “Gold Standard” outcome measure i.e. Yale Brown Obsessive Compulsive Scale (Y-BOCS)
Two fold criterion for recovery on Y-BOCS:
a) Statistically significant improvement following Tx
b) Post-treatment score closer to a functional rather than dysfunctional population
-Asymptomatic criterion: 7 points or less on Y-BOCS
Why are more effective interventions needed + what issues need to be considered when interpreting results?
-Approximately 60% of people continue to experience symptoms following psychological interventions.
However there are other issues to consider when interpreting results:
-Therapist competency
-Inclusion/exclusion criteria of the RCTs
Treatment Adherence:
-15% of eligible people refused psychological Tx
-16% of treatment starters dropped out of psychological Tx (Leeuwerik, Cavanagh, & Strauss, 2019)
What are the Metacognitive Beliefs about Obsessions?
Thought-Action Fusion (TAF):
“Imaging a knife in his chest means I am going to stab my psychologist”
Thought-Event Fusion (TEF):
“Thinking that I committed a murder means I did”
“Having an image of germs means I am contaminated”
Thought-Object Fusion (TOF):
“Negative feelings can be passed into my possessions
What are the Metacognitive Beliefs about Rituals?
“My rituals give me peace of mind by getting the bad thoughts out of my head”
“I must wash until I remove the thoughts from my mind and then I feel calmer”
“Checking that the door is locked stops me worrying”
“ Rituals prevent anxiety from overwhelming me”
What is the Role of Metacognition in OCD?
Multiple studies have been conducted to test if metacognition can explain symptoms of OCD when the effects of cognition have been accounted for.
What are the Belief domains and OCD symptoms? (Myers, Fisher & Wells, 2008)
Cognitive Beliefs:
-Perfectionism / Certainty
-Responsibility
Metacognitive Beliefs:
-Importance and control of thoughts
General Constructs:
-Worry
-Overestimation of threat
What are some conclusions on Myers, Fisher & Well’s (2008) study?
-Thought fusion (metacognitive) beliefs prospectively and independently predict OCD symptoms controlling for baseline symptoms, worry and cognitive beliefs.
-Metacognitive thought fusion beliefs implicated in the development of OCD.
What was the purpose and hypothesis of Fisher & Well’s (2005) study: Modifying Metacognitive Beliefs in OCD - An Experimental Study
Compare the effects of brief exposure presented with a metacognitive rationale (ERP-E)with the effects of brief ERP presented with a habituation rationale (ERP)
Hypotheses:
ERP-E would be more effective than ERP in:
1. reducing conviction in metacognitive fusion beliefs
2. lowering anxiety/distress
3. decreasing the urge to neutralise
What was the design of Fisher & Well’s (2005) study?
-Counterbalanced repeated measures crossover design.
-Independent variable: Treatment rationale ERP-E vs ERP
Dependent variables:
-Anxiety/distress
-Strength of metacognitive belief
-Urge to neutralise/perform rituals
What was the participant design of Fisher & Well’s (2005) study?
-8 consecutive referrals to Clinical Psychology
-Primary diagnosis of OCD
-Obsessions and Compulsions (overt & covert)
-OCD for at least one year (range 7- 41yrs)
-18-65
-No concurrent psychological treatment
What was the Experimental Procedure of Fisher & Well’s (2005) study?
- Metacognitive beliefs about intrusions elicited
- Intrusive thoughts transcribed verbatim
- Intrusions recorded onto closed loop tape.
- Each patient received a BAT, plus the 2 counterbalanced experimental conditions.
- Ratings of DV’s made at 1, 3, 5 minutes
- Following the BAT, patients received either ERP-E or ERP in a counterbalanced order.
- Experimental rationales given and patients asked to bear in mind during forthcoming exposure.
- Credibility and suitability ratings taken for ERP-E and ERP conditions.
What are some examples of Main Metacognitive Beliefs? Some examples of the thought fusion beliefs
“Doubts are always meaningful and mean I haven’t checked.”
“Thoughts about incest means I want to be incestuous”
“Thinking that the cats are choking to death means that it is happening.”
“My thoughts can influence the action of the devil”
