The principal goal of the current study was to compare the efficacy of two treatment formats, group and individual, of an empirically proven manualized cognitive-behavioural treatment (CBT) package, for obsessions without overt compulsions. It was hypothesized that individualized treatment would be more effective both in terms of post-treatment group mean improvement and end state functioning. A secondary goal was to assess the relationship between cognitive and behavioural change during treatment and link it to symptom change. Both group and individual CBT format produced a significant clinical change, but as expected individual treatment produced the greater change in symptoms and in obsessional belief. Also, the individual format showed a clear superiority over the group format in the reduction of anxiety and depression. Severity of OCD symptoms showed little relationship with strength of obsessional beliefs at the start of treatment, but change in beliefs was strongly correlated with behavioural improvement post-treatment. The results of the study suggest that the impact of a group format may lie in the value of shared social support and motivational effect of peer feedback, but at the expense of individualized targets.
Two related studies explored the contribution of cognitive interventions to aiding`habit reversal' treatment in chronic tic disorders. In the first study, two groups of chronic tic disordered subjects received either a standard behavioural intervention, modelled on Azrin and Nunn's (1973)`habit reversal' technique (n 7) or, a cognitive-oriented treatment aimed at modifying anticipations in high risk tic situations (n 7). The two groups were matched pre-treatment, and clinically assessed post treatment, and at 3-month and 2-year follow-up. There were no significant differences in clinical outcome, and both groups showed lower EMG level, and reported reduced tic frequency, and an increased degree of control over the tic. In a second series of case studies, the cognitive approach was extended to modify not only anticipations in high risk situations, but also the tic clients' overactive style of planning action. The cognitive model views perfectionist expectations about personal organization as a source of the frustration, and tension, which can provoke tics. In conclusion, although a cognitive approach may not be necessary to reduce tic frequency, it can facilitate tic management.
Thirteen subjects experiencing chronic tics kept diaries noting frequency, intensity and degree of control of their tic during their daily routines for one week. Three examples of high-, medium- and low-risk situations were chosen as elements and, using a modified form of Kelly's repertory grid, bipolar constructs were elicited by comparing the three types of situations. Principal dimensions extracted from INGRID analyses differed across individuals but related to three principal areas; self-image, degree of task involvement and type of task demand. Feelings of impatience and frustration frequently accompanied tic onset. Subjects' cognitive evaluations of their tic situations may be important in tic management.
12 clients suffering from chronic tics participated in one of two treatment programs, either a behavioral group using competing response therapy or a group using Beck-style cognitive restructuring. A repertory grid based upon the personal construct psychology of George Kelly was administered to all clients before and after treatment. The grid comprised a set of elements made up of situations with high, medium, and low risk of eliciting tics, and constructs were derived from comparisons between them. Clients' ratings of the elements on the constructs were subjected to a principal components analysis using an INGRID program. Following treatment the total variation around construct means decreased in both groups but significantly more in the cognitive group, indicating a narrowing of the difference in their perceptions of situations which formerly indicated high and low risk of inducing tics.
Two related studies explored the contribution of cognitive interventions to aiding`habit reversal' treatment in chronic tic disorders. In the first study, two groups of chronic tic disordered subjects received either a standard behavioural intervention, modelled on Azrin and Nunn's (1973)`habit reversal' technique (n 7) or, a cognitive-oriented treatment aimed at modifying anticipations in high risk tic situations (n 7). The two groups were matched pre-treatment, and clinically assessed post treatment, and at 3-month and 2-year follow-up. There were no significant differences in clinical outcome, and both groups showed lower EMG level, and reported reduced tic frequency, and an increased degree of control over the tic. In a second series of case studies, the cognitive approach was extended to modify not only anticipations in high risk situations, but also the tic clients' overactive style of planning action. The cognitive model views perfectionist expectations about personal organization as a source of the frustration, and tension, which can provoke tics. In conclusion, although a cognitive approach may not be necessary to reduce tic frequency, it can facilitate tic management.
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