A Randomized Controlled Trial of Cognitive Therapy versus Intensive Behavior Therapy in Obsessive Compulsive Disorder

Abstract

Background: The study was designed to compare cognitive therapy (CT) with intensive behavior therapy (BT) in obsessive-compulsive disorder (OCD) and to study their change process. Methods: Sixty-five outpatients with DSM-4 OCD were randomized into 2 groups for 16 weeks of individual treatment in 3 centers. Group 1 received 20 sessions of CT. Group 2 received a BT program of 20 h in two phases: 4 weeks of intensive treatment (16 h), and 12 weeks of maintenance sessions (4 h). No medication was prescribed. Results: Sixty-two patients were evaluated at week 4, 60 at week 16 (post-test), 53 at week 26 and 48 at week 52 (follow-up). The response rate was similar in the 2 groups. The Beck Depression Inventory (BDI) was significantly more improved by CT (p = 0.001) at week 16. The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT, while the baseline BDI score predicted a response in BT. At week 16, only the changes in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a scale measuring the interpretation of intrusive thoughts correlated in CT, while the changes in Y-BOCS, BDI, and interpretation of intrusive thoughts correlated in BT. Improvement was retained at follow-up without a between-group difference. The intent-to-treat analysis (last observation carried forward) found no between-group differences on obsessions, rituals and depression. Conclusions: CT and BT were equally effective on OCD, but at post-test CT had specific effects on depression which were stronger than those of BT. Pathways to improvement may be different in CT and BT. The outcomes are discussed in the light of an effect size analysis.

A terapia cognitivo-comportamental no transtorno obsessivo-compulsivo

“…24,25,32,33 In parallel, some clinical trials have proven the effectiveness of using cognitive therapy alone for the treatment of OCD, [34][35][36][37][38] both for patients who have predominantly obsessions, 39 who had been considered refractory to ERP therapy, and for patients with obsessions and compulsions. 40,41 It was also seen a similar efficacy of cognitive and ERP therapies. 36,38,40,41 Some of those studies, however, have undergone criticism: the time period destined to behavioral therapy was shorter than that dedicated to cognitive therapy.…”

“…40,41 It was also seen a similar efficacy of cognitive and ERP therapies. 36,38,40,41 Some of those studies, however, have undergone criticism: the time period destined to behavioral therapy was shorter than that dedicated to cognitive therapy. It was questioned if therapists did not suggest, even indirectly, home tasks and if it was ethical to request patients to not try to perform exposure or refrain from doing their rituals.…”

Cognitive Restructuring

“…Like other anxiety disorders, a CBT approach to treatment of obsessions and compulsions that includes a strong CR component does lead to significant immediate and long-term symptom reduction (e.g., Freeston et al, 1997;McLean et al, 2001;van Oppen et al, 1995;Whittal, Robichaud, Thordarson, & McLean, 2008;Whittal, Thordarson, & McLean, 2005). Furthermore, it is apparent that CR alone can have a significant treatment effect even in the absence of systematic, intensive ERP (Cottraux et al, 2001;Whittal et al, 2005;Wilson & Chambless, 2005). Although some studies have found CBT equivalent to ERP (Cottraux et al, 2001;Whittal et al, 2005), others reported that intensive ERP alone is more effective than CBT (McLean et al, 2001) or that adding CR to ERP did not significantly improve treatment outcome (O'Connor et al, 2005).…”

“…Furthermore, it is apparent that CR alone can have a significant treatment effect even in the absence of systematic, intensive ERP (Cottraux et al, 2001;Whittal et al, 2005;Wilson & Chambless, 2005). Although some studies have found CBT equivalent to ERP (Cottraux et al, 2001;Whittal et al, 2005), others reported that intensive ERP alone is more effective than CBT (McLean et al, 2001) or that adding CR to ERP did not significantly improve treatment outcome (O'Connor et al, 2005). Moreover, Whittal, Woody, McLean, Rachman, and Robichaud (2010) found that CBT and stress management were equally effective in treating individuals who experienced obsessions without overt compulsions.…”

Aristides Volpato Cordioli responde

“…[1][2][3][4] Um dos estudos observou uma eficácia superior da terapia cognitiva, comparada à terapia comportamental, em reduzir os sintomas depressivos em portadores do TOC 4 -uma comorbidade relativamente freqüente, embora a eficácia em reduzir os sintomas obsessivo-compulsivos fosse semelhante. McLean et al 1 observaram uma leve vantagem da terapia de EPR em grupo com relação à terapia cognitiva (TC) em grupo.…”