Barrett, P., Farrell, L., Dadds, M. & Boulter, N. (2005). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: Long-term follow-up and predictors of outcome. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1005-1014.

Correspondence Address:
Paula Barrett, School of Applied Psychology, Griffith University, Mount Gravatt Campus, Brisbane, QLD, Australia, 4111, p.barrett@griffith.edu.au.

Abstract
Objective: The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome. Method: Undertaken at a university-based clinic, this study involved 48 participants (8-19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome. Results: Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome. Conclusions: The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief and that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Biondi, M., & Picardi, A. (2005). Increased Maintenance of Obsessive-Compulsive Disorder Remission after Integrated Serotonergic Treatment and Cognitive Psychotherapy Compared with Medication Alone. Psychotherapy & Psychosomatics, 74, 123-128.

Correspondence Address:
Biondi, Massimo, III Clinica Psichiatrica, Dipartimento di Scienze Psichiatriche e Medicina Psicologica, Universita 'La Sapienza', Viale dell'Universita, Rome, Italy, IT-30-00185, massimo.biondi@uniroma1.it.

Abstract
(from the journal abstract) Background: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone. Methods: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score <= 10 and Global Assessment of Functioning (GAP) scale score >=70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12-24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients' preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAP scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse. Results: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p<0.001) in the integrated treatment group (132 months, 95% CI 107-157) than in the medication group (25 months, 95% CI 12-38). Conclusions: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Park, H. S., Shin, Y. W., Ha, T. H., Shin, M. S., Kim, Y. Y., Lee, Y. H., & Kwon, J. S. (2006). Effect of cognitive training focusing on organizational strategies in patients with obsessive-compulsive disorder. Journal Psychiatry and Clinical Neurosciences, 60, 718-726.

Correspondence Address:
Jun Soo Kwon, Department of Psychiatry, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, Korea, 110-744, kwonjs@plaza.snu.ac.kr.

Abstract
The purpose of the present paper was to develop a cognitive training program for patients with obsessive-compulsive disorder (OCD) and evaluate its effectiveness. Nine 60-min sessions focusing on the improvement of organizational strategies were given to 15 patients with OCD over a period of 5 weeks. The control group consisted of 15 age- and sex-matched patients also with OCD. The Rey-Osterrieth Complex Figure Test and Korean-California Verbal Learning Test were administered before and after cognitive training. Clinical symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale. The memory function in the treatment group improved and their clinical symptoms were alleviated after training, compared to those of the control group. Cognitive training of OCD patients not only improved their memory function, but also alleviated their clinical symptoms. Therefore, cognitive training, focusing on the improvement of organizational strategies, could be an effective treatment modality for patients with OCD. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008 Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clinical Psychology Review, 28 (8), 1310-1325.

Correspondence Address:
Julio Sánchez-Meca, Department Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Espinardo Campus, Murcia, Spain, 30100, jsmeca@um.es.

Abstract
The benefits of cognitive-behavioral treatment for obsessive-compulsive disorder (OCD) have been evidenced by several meta-analyses. However, the differential effectiveness of behavioral and cognitive approaches has shown inconclusive results. In this paper a meta-analysis on the effectiveness of psychological treatment for OCD is presented by applying random- and mixed-effects models. The literature search enabled us to identify 19 studies published between 1980 and 2006 that fulfilled our selection criteria, giving a total of 24 independent comparisons between a treated and a control group. The effect size index was the standardized mean difference in the posttest. The effect estimates for exposure with response prevention (ERP) alone (d-super(+) = 1.127), cognitive restructuring (CR) alone (d-super(+) = 1.090), and ERP plus CR (d-super(+) = 0.998) were very similar, although the effect estimate for CR alone was based on only three comparisons. Therapist-guided exposure was better than therapist-assisted self-exposure, and exposure in vivo combined with exposure in imagination was better than exposure in vivo alone. The relationships of subject, methodological and extrinsic variables with effect size were also examined, and an analysis of publication bias was carried out. Finally, the implications of the results for clinical practice and for future research in this field were discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Steketee, G., Frost, R. O., Tolin, D. F., Rasmussen, J., & Brown, T. A. (2010). Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder. Depression and Anxiety ,27(5), 476-484.

Correspondence Address:
Steketee, Gail: Boston University School of Social Work, 264 Bay State Rd., Boston, MA, US, 02215-1409, steketee@bu.edu.

Abstract
This study investigated a multicomponent cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). Method: Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of the 46 patients randomly assigned to CBT or waitlist (WL), 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to nonacquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. Results: After 12 weeks, CBT participants benefited significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 71% of patients were considered improved on therapist clinical global improvement ratings and 81% of patients rated themselves improved; 41% of completers were clinically significantly improved. Conclusions: Multicomponent CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern, and further research with independent assessors is needed to establish treatment benefits and durability of gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Vogel, P. A., Stiles, T. C., & Gotestam, K.G. (2004). Adding cognitive therapy elements to exposure therapy for obsessive compulsive disorder: A controlled study. Behavioural and Cognitive Psychotherapy, 32, 275-290.

Correspondence Address:
Patrick A. Vogel, Department of Psychology, Norwegian University of Science and Technology (NTNU)-Dragvoll, Trondheim, Norway, 7491, patrickv@svt.ntnu.no.

Abstract
Thirty-five outpatients (25 women, 10 men) with a DSM-III-R principal diagnosis of OCD accepted exposure treatment at a psychiatric outpatient clinic. They were randomly assigned to one of two individual treatments for a 6-week exposure therapy treatment based on a treatment manual or to a 6-week waiting list condition. The 12 patients assigned to the waiting list were subsequently randomly assigned to one of the active treatments. Both treatment groups received in vivo or imaginal exposure in each of the 10 twice-weekly treatment sessions held after two assessment sessions. One group (n= 16) received cognitive therapy interventions for comorbidity problems or to alter beliefs underlying patients' OCD. The other group (n= 19) received relaxation training as an attention placebo control. Both groups received relapse prevention follow-up contacts. Twenty-seven patients completed intensive treatment. Both treatments overall showed satisfactory levels of clinical improvement and large effect sizes. ANCOVAS for treatment completers showed non-significantly lower levels of OCD symptoms, depression and state anxiety in the treatment condition that did not include cognitive interventions. The patients receiving additional cognitive therapy showed significantly lesser dropout than those in the other treatment condition, but there were no significant differences in the intention-to-treat analyses. (PsycINFO Database Record (c) 2005 APA,all rights reserved)

Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology, 76 (6), 1003-1014.

Correspondence Address:
Maureen L. Whittal, Anxiety Disorders Clinic, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada, V6T 2B5, whittal@interchange.ubc.ca.

Abstract
Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Wilson, K. A., & Chambless, D. L. (2005). Cognitive therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 43, 1645-1654.

Correspondence Address:
Kimberly A. Wilson, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Centre, 401 Quarry Road, Stanford, CA, US, 94305-5722, kawilson@stanford.edu.

Abstract
A multiple baseline across subjects design was used to test the efficacy of cognitive therapy for obsessive-compulsive disorder (OCD). Six people with OCD received 10-18 sessions of weekly, outpatient cognitive therapy. Assessment included both structured interviews and diary data. For three to four of the six patients, stable baseline periods were followed by reductions of symptoms during intervention. Two clients met stringent criteria for Jacobson and Truax's (J. Consulting Clin. Psychol. 59 (1991) 12) recovered status at posttest according to the Yale-Brown Obsessive-Compulsive Scale (Arch. Gen. Psychiatry 46 (1989) 1006). For the group, large pretest-posttest effect sizes were found. (PsycINFO Database Record (c) 2006 APA, all rights reserved)