Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder.

Adult Cognitive Behavioral Therapy Combined Modality Therapy Humans Obsessive-Compulsive Disorder / therapy Patient Compliance Selective Serotonin Reuptake Inhibitors / therapeutic use Treatment Outcome
CBT Cognitive-behavioral therapy EX/RP Exposure and ritual prevention OCD Obsessive-compulsive disorder

Journal

Behaviour research and therapy
ISSN: 1873-622X
Titre abrégé: Behav Res Ther
Pays: England
ID NLM: 0372477

Informations de publication

Date de publication:
08 2021
Historique:
received: 11 12 2020
revised: 31 03 2021
accepted: 18 05 2021
pubmed: 6 6 2021
medline: 26 10 2021
entrez: 5 6 2021
Statut: ppublish

Résumé

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.

Identifiants

DOI: 10.1016/j.brat.2021.103890 PMID: 34089924 PMC: PMC8241471
pubmed: 34089924
pii: S0005-7967(21)00089-9
doi: 10.1016/j.brat.2021.103890
pmc: PMC8241471
mid: NIHMS1709963
pii:
doi:

Substances chimiques

Serotonin Uptake Inhibitors 0

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

103890

Subventions

Organisme : NIMH NIH HHS
ID : R01 MH045404
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH045436
Pays : United States

Informations de copyright

Copyright © 2021 Elsevier Ltd. All rights reserved.

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Auteurs

Helen B Simpson (HB)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA. Electronic address: Blair.Simpson@nyspi.columbia.edu.

Edna B Foa (EB)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Michael G Wheaton (MG)

New York State Psychiatric Institute, New York, NY, 10032, USA; Barnard College, Columbia University, New York, NY, 10027, USA.

Thea Gallagher (T)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Marina Gershkovich (M)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Andrew B Schmidt (AB)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Jonathan D Huppert (JD)

The Hebrew University of Jerusalem, Israel.

Raphael B Campeas (RB)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Patricia A Imms (PA)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Shawn P Cahill (SP)

University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA.

Christina DiChiara (C)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA.

Steven D Tsao (SD)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA.

Anthony C Puliafico (AC)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Daniel Chazin (D)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Anu Asnaani (A)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA.

Kelly Moore (K)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA.

Jeremy Tyler (J)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Shari A Steinman (SA)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychology, WVU, Morgantown, WV, 26506, USA.

Arturo Sanchez-LaCay (A)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Sandy Capaldi (S)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Ivar Snorrason (I)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA.

Elizabeth Turk-Karan (E)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Donna Vermes (D)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Eyal Kalanthroff (E)

The Hebrew University of Jerusalem, Israel.

Anthony Pinto (A)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA.

Chang-Gyu Hahn (CG)

Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Bin Xu (B)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA.

Page E Van Meter (PE)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Martha Katechis (M)

Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.

Jennifer Scodes (J)

New York State Psychiatric Institute, New York, NY, 10032, USA.

Yuanjia Wang (Y)

Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Disciplines et activités comportementales › Psychothérapie › Thérapie comportementale › Thérapie cognitive › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Thérapeutique › Association thérapeutique › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Troubles mentaux › Troubles anxieux › Trouble obsessionnel compulsif › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude envers la santé › Adhésion et observance thérapeutiques › Acceptation des soins par les patients › Observance par le patient › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Agents neuromédiateurs › Agents sérotoninergiques › Inhibiteurs sélectifs de la recapture de la sérotonine › Maximizing remission from cognitive-behavioral...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Maximizing remission from cognitive-behavioral...