Alain Sauteraud

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

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.

Validity and factor structure of the Obsessive Compulsive Thoughts Checklist

The Obsessive Compulsive Thoughts Checklist (OCTC; Bouvard, Mollard, Cottraux, & Guerin 1989) is a 28 item questionnaire. Patients rate their degree of disturbance of the past week on a 5-point scale. The validation study and factor analysis of the OCTC is presented. Three groups were compared: patients suffering from obsessive compulsive disorders (n = 122), patients suffering from panic disorder with agoraphobia (n = 61) and a control group (n = 80). The three groups were comparable in age and sex. Obsessive compulsive patients scored significantly higher than both agoraphobic patients and control subjects. Spearman rank correlations were used to compute convergent validity in a sub-group of obsessive compulsive patients (n = 96). The Obsessive Compulsive Thoughts Checklist correlated positively with the Compulsive Activity Checklist (rho =. 62; p <. 0001). The total score was also positively correlated with the Yale-Brown Obsessive Compulsive Scale (YBOCS total scale: rho =. 42; p <. 0001; YBOCS obsession scale: rho =. 40; p <. 0001; YBOCS compulsion scale: rho. 37; p =. 0002). The factor structure was studied both on the sample which included agoraphobic patients and controls (n = 141) and on the obsessive compulsive patients only (n = 122). In both analyses, three identical factors were found: – factor 1: checking/perfectionism-orderliness – factor 2: responsibility/dread of harming others – factor 3: washing/contamination. Results support the validity and the internal consistency of the Obsessive Compulsive Thoughts Checklist. The factor analysis indicates that the OCTC is a three dimensional scale, reflecting a pathological need to check, a pathological sense of responsibility and a pathological need to wash, probably due to distorted thoughts about perfectionism and orderliness, an excessive need for control and fear of contamination.

Dreams in obsessive-compulsive disorder: an analysis of semantic and emotional content compared to controls.

OBJECTIVE We sought to investigate the content of the dreams of obsessive-compulsive outpatients in the light of the following postulate: if dreams play a role in the processing of information and mental storage of events of the day, the dream recollections of obsessive-compulsive disorder (OCD) patients should present evidence of diurnal obsessive or ritual themes. METHOD On seven successive mornings, immediately after awakening in their home environment, 10 nondepressed OCD patients and 11 controls recorded their recollections of the nights dreams on an audiotape. After randomization of dreams, two judges were asked to carry out a blind evaluation of the emotional characteristics perceptible in these dreams and the presence of obsessive or ritual themes. RESULTS 47 dreams were collected in the OCD group and 55 in the control group. No differences were found between the two groups regarding anxiety, sadness, the theme of failure, or the presence of obsessive or ritual themes. About 60% of OCD patients and 73% of the control group recounted dreams expressing anxiety, sadness, or failure. Most surprisingly, in the control group as well as in the OCD group, about one-third of subjects presented obsessive or ritual themes in their dreams. CONCLUSION These data suggest that there is no evident link between diurnal mental activity and the morning recollection of nocturnal dreams regarding anxiety, failure, sadness, and obsessive-compulsive themes.

Processing of Obsessive, Responsibility, Neutral Words and Pseudo-Words in Obsessive-Compulsive Disorder: A Study with Lexical Decision Test

Twenty-four DSM-III-R non-depressed obsessive-compulsive (OCD) patients were compared to 21 normal subjects in three lexical decision experiments, to distinguish neutral, obsessive and responsibility words from pseudo-words. Error frequencies were comparable across groups. A significant taboo effect was found in both groups for obsessive and responsibility words. OCD patients did not differ from control subjects in their processing of neutral words and responsibility words. However, OCD patients were significantly slower than controls when processing obsessive words. Furthermore, OCD patients processed pseudo-words slower than controls if these were presented in the same experiment as obsessive words. When mixed with neutral or responsibility words, the performance of OCD patients with pseudo-words was similar to that of control subjects. The level of sub-clinical depression (as appreciated on the HAM-D scale) and psychotropic drugs (such as serotonin reuptake inhibitor) did not modify these results. Lexical decision performances were interpreted in terms of a cognitive disturbance triggered by obsessive stimuli that spreads to a neutral task. These results are compatible with the cognitive model of OCD (Salkovskis, 1985).

Virtual human as a new diagnostic tool, a proof of concept study in the field of major depressive disorders

Embodied Conversational Agents (ECAs) are promising software to communicate with patients but no study has tested them in the diagnostic field of mental disorders. The aim of this study was 1) to test the performance of a diagnostic system for major depressive disorders (MDD), based on the identification by an ECA of specific symptoms (the MDD DSM 5 criteria) in outpatients; 2) to evaluate the acceptability of such an ECA. Patients completed two clinical interviews in a randomized order (ECA versus psychiatrist) and filled in the Acceptability E-scale (AES) to quantify the acceptability of the ECA. 179 outpatients were included in this study (mean age 46.5 ± 12.9 years, 57.5% females). Among the 35 patients diagnosed with MDD by the psychiatrist, 14 (40%) patients exhibited mild, 12 (34.3%) moderate and 9 (25.7%) severe depressive symptoms. Sensitivity increased across the severity level of depressive symptoms and reached 73% for patients with severe depressive symptoms, while specificity remained above 95% for all three severity levels. The acceptability of the ECA evaluated by the AES was very good (25.4). We demonstrate here the validity and acceptability of an ECA to diagnose major depressive disorders. ECAs are promising tools to conduct standardized and well-accepted clinical interviews.

Could a virtual human be used to explore excessive daytime sleepiness in patients

Excessive daytime somnolence (EDS) is defined as the inability to stay awake in daily life activities. Several scales have been used to diagnose excessive daytime sleepiness, the most widely used being the Epworth Sleepiness Scale (ESS). Sleep disorders and EDS are very common in the general population. It is therefore important to be able to screen patients for this symptom in order to obtain an accurate diagnosis of sleep disorders. Embodied Conversational Agents (ECA) have been used in the field of affective computing and human interactions but up to now no software has been specifically designed to investigate sleep disorders. We created an ECA able to conduct an interview based on the ESS and compared it to an interview conducted by a sleep specialist. We recruited 32 consecutive patients and a group of 30 healthy volunteers free of any sleep complaints. The ESS is a self-administered questionnaire that asks the subject to rate (with a pen and paper paradigm) his or her probability of falling asleep. For the purpose of our study, the ECA or real-doctor questionnaire was modified as follows: Instead of the “I” formulate, questions were asked as “Do you.” Our software is based on a common 3D game engine and several commercial software libraries. It can run on standard and affordable hardware products. The sensitivity and specificity of the interview conducted by the ECA were measured. The best results (sensibility and specificity >98%) were obtained to discriminate the sleepiest patients (ESS ≥16) but very good scores (sensibility and specificity >80%) were also obtained for alert subjects (ESS<8). ESS scores obtained in the interview conducted by the physician were significantly correlated with ESS scores obtained in the interview the ECA conducted. Most of the subjects had a positive perception of the virtual physician and considered the interview with the ECA as a good experience. Sixty-five percent of the participants felt that the virtual doctor could significantly help real physicians. Our results show that a virtual physician can conduct a very simple interview to evaluate EDS with very similar results to those obtained by a questionnaire administered by a real physician. The expected massive increase in sleep complaints in the near future likely means that more and more physicians will be looking for computerized systems to help them to diagnose their patients.

Acceptability of Embodied Conversational Agent in a Health Care Context

While the interest of Embodied Conversational Agents (ECA) in health care context increased, the extent to which patients find ECAs acceptable should be more evaluated. Thus, in this study, we evaluated the acceptability of an ECA who conducts a clinical structured interview to make a medical diagnosis, in comparison with the same clinical structured interview presented in written form on a tablet screen. 178 patients participated to the study (102 females (57.3 %); Mean age = 46.5 years ± 12.9, range 19–64; Mean educational level = 13.3 years ± 3.1). It was showed that patients perceived globally the acceptability of the ECA higher than the tablet. This higher acceptability was linked rather to higher satisfaction than to higher usability. Moreover, the patients were more satisfied when they repeated the clinical interview with the ECA than with the tablet. Thus ECA usage could avoid the decrease of satisfaction of repeated computerized clinical interviews.