Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial

Abstract

BackgroundObsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them.Methods/DesignThis is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnosed with OCD will be allocated at random to a 10-session ERP group or to a 10-session MB-ERP group. Primary outcomes are OCD symptom severity and therapy engagement. Secondary outcomes are depressive symptom severity, wellbeing and obsessive-compulsive beliefs. A semi-structured interview with participants will guide understanding of change processes.DiscussionFindings from this pilot study will inform future research in this area, and if effect sizes on primary outcomes are in favour of MB-ERP in comparison to ERP, funding for a definitive trial will be sought.Trial registrationCurrent Controlled Trials registration number ISRCTN52684820. Registered on 30 January 2014.

Evidence-Based Assessment of Obsessive–Compulsive Disorder

“…44,47-49 The Y-BOCS-II shows preliminary support for treatment sensitivity in a case report, with further examination in a large treatment sample needed. 50,51 Sensitivity of the Y-BOCS-II has been shown to be very high (ie, 85% of OCD patients correctly identified) with comparably lower specificity (ie, 62%–70% of individuals with non-OCD diagnoses correctly identified as not having OCD). 52…”

Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial

“…Greater pretreatment OCD severity has been associated with larger posttreatment effect sizes of face-to-face CBT, although not consistently across all studies [ 9 - 12 ]. While other psychological treatments have been applied to OCD, inclusive of progressive relaxation [ 13 - 16 ] and acceptance and commitment therapy [ 17 ], these interventions lack an extensive evidence base for their efficacy. Pharmacological treatments have also been found to be effective in treating OCD, particularly serotonergic agents, although cognitive behavioral treatments are more effective among outpatients with OCD [ 18 ].…”

Mindfulness-based cognitive therapy for obsessive-compulsive disorder: Study protocol for a randomized controlled trial with functional magnetic resonance imaging and a 6-month follow-up

“…Kulz et al (2014) evaluated the effectiveness of an eight-session MBCT programme in a large sample of OCD patients who had residual symptoms after completing traditional CBT compared with psycho-education. To reduce the rate of dropout and to work on obsessive thoughts, Strauss et al (2015) designed a pilot RCT to explore the effect of a 10-session mindfulness-based exposure and response prevention treatment compared with ERP. As the only RCT assessing clinical outcomes of MBCT for OCD, the study of Key and colleagues (Key et al, 2017) showed that MBCT can be an augmentation treatment for OCD patients who have residual symptoms following the completion of CBT.…”