Elisabeth Meyer

A Randomized Clinical Trial to Examine Enhancing Cognitive-Behavioral Group Therapy for Obsessive-Compulsive Disorder with Motivational Interviewing and Thought Mapping

BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. AIMS A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. METHOD Subjects were randomized (n=93) into a CBGT group or a CBGT group with MI+TM. RESULTS When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. CONCLUSIONS Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory: Revised (OCI-R)

OBJECTIVE The present study was designed to evaluate the psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised. METHOD The Obsessive-Compulsive Inventory - Revised was administered to a total of 260 participants: a clinical sample of 130 patients with anxiety disorders (64 with a diagnosis of obsessive-compulsive disorder patients, 33 diagnosed with social phobia, and 33 with panic disorder) and a sample of 130 non-clinical subjects. RESULTS The findings indicate that the Obsessive-Compulsive Inventory - Revised is a valid measure for identifying and assessing the severity of the six symptom subtypes in obsessive-compulsive disorder. The original factor structure of the instrument was replicated in an exploratory factor analysis. Test-retest reliability was examined using data from 64 obsessive-compulsive disorder patients who completed the inventory on two different occasions. In each sample, the overall and subscale scores showed moderate to good internal consistency, good convergent and divergent validity, and sensitivity to changes resulting from cognitive-behavioral group therapy. CONCLUSION Our findings indicate that the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised retains the psychometric properties of its original version and the Spanish, German and Icelandic versions.

Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial

OBJECTIVE Recent factor-analytic studies of obsessive-compulsive disorder identified consistent symptom dimensions. This study was designed in order to observe which obsessive compulsive symptom dimensions could be changed by adding two individual sessions of motivational interviewing and thought mapping of cognitive-behavioral group therapy using a randomized clinical trial. METHOD Forty outpatients with a primary diagnosis of obsessive-compulsive disorder were randomly assigned to receive cognitive-behavioral group therapy (control group) or motivational interviewing+thought mapping plus cognitive-behavioral group therapy. To evaluate changes in symptom dimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale was administered at baseline and after treatment. RESULTS At post-treatment, there were statistically significant differences between cognitive-behavioral group therapy and motivational interviewing+thought mapping+cognitive behavioral group therapy groups in the mean total Dimensional Yale-Brown Obsessive-Compulsive Scale score, and in the contamination and aggression dimension score. Hoarding showed a statistical trend towards improvement. CONCLUSION These findings suggest that adding motivational interviewing+thought mapping to cognitive-behavioral group therapy can facilitate changes and bring about a decrease in the scores in different obsessive-compulsive disorder symptom dimensions, as measured by the Dimensional Yale-Brown Obsessive-Compulsive Scale. Nonetheless, additional trials are needed to confirm these results.

Patient and family factors associated with family accommodation in obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) impacts family functioning as family members modify their personal and family routines, participate in rituals, and provide reassurance. These behaviors have been identified as family accommodation (FA), a phenomenon that, if ignored, may facilitate OCD symptoms and lead to poorer prognosis. Because FA has been recognized as a predictor of treatment outcome, we examined the prevalence of FA and identified patient and family sociodemographic and clinical variables associated with FA in an outpatient sample.

Adaptation for Brazilian Portuguese of a scale to measure willingness to wear condoms.

INTRODUCTION We describe the process of translation and adaptation into Brazilian Portuguese of the Stages of Change for Condom Use, developed at the University of Rhode Island, USA. The scale aims to evaluate the readiness to wear condoms based on the Stages of Change model. The goal of this study was to translate, perform the necessary adaptations and evaluate the applicability of the scale in Brazilian Portuguese. METHOD A first Portuguese version of the scale, complying with internationally accepted criteria for transcultural adaptation of instruments, was applied to 15 individuals who differed regarding their sociodemographic variables. RESULTS adjustments were needed in order to render the adaptation viable, what allowed to obtain the final version of the Stages of Change for Condom Use. Subjects of this sample demonstrated good acceptance and understanding of the items presented in the scale. CONCLUSION The utilization of the scale with individuals of different sociodemographic strata enabled the necessary adaptations to the Brazilian sociocultural reality and to the level of understanding of ordinary individuals.

Translation and adaptation into Brazilian Portuguese of the Family Accommodation Scale for Obsessive-Compulsive Disorder - interviewer-Rated (FAS-IR)

OBJETIVO: Descrever o processo de traducao e adaptacao para o portugues do Brasil da Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). METODO: O processo de traducao e adaptacao da escala envolveu quatro profissionais de saude bilingues. A escala foi inicialmente traduzida de forma independente para o portugues do Brasil por dois profissionais. A seguir, as duas versoes foram comparadas, resultando em uma versao inicial em portugues que foi aplicada a 15 familiares de pacientes com transtorno obsessivo-compulsivo (TOC), com diferentes niveis de instrucao, deliberadamente escolhidos para coletar as sugestoes de ajuste linguistico. Subsequentemente, a escala foi retrotraduzida independentemente por outros dois profissionais da saude. Depois de comparar as duas retrotraducoes, uma nova versao da escala foi gerada em ingles. Essa versao foi revisada e aprovada pelos autores da escala original. RESULTADOS: A versao em portugues do Brasil da escala FAS-IR mostrou ser facilmente compreendida e pode ser usada em familiares de pacientes com TOC de diferentes niveis socioeconomicos. CONCLUSAO: A FAS-IR adaptada ao portugues do Brasil fara com que profissionais de saude possam avaliar o nivel de acomodacao em familiares de pacientes com TOC e permitira a realizacao de futuros estudos com os objetivos de 1) estudar a influencia da acomodacao familiar na manutencao e, possivelmente, na facilitacao dos sintomas do TOC e 2) examinar o efeito da acomodacao familiar sobre os resultados do tratamento em populacoes de paises de lingua portuguesa.

Cognitive-Behavioral Group Therapy versus Sertraline for Obsessive-Compulsive Disorder: Five-Year Follow-Up

ated 5 years after the end of the initial randomized clinical trial. All subjects provided written informed consent that was approved by the institutional review board. The Yale-Brown Scale for Obsessive-Compulsive Symptoms (Y-BOCS) [5, 6] and the Clinical Global Impression scale – Severity (CGI-S, adapted version) [7] were used to assess the severity of OCD symptoms. The Beck Depression Inventory (BDI) [8, 9] and Beck Anxiety Inventory (BAI) [10, 11] were used to assess depressive and anxiety symptoms, respectively. Both patients treated with CBGT and those treated with sertraline showed a significant reduction in the severity of symptoms at the end of the treatments, and they maintained therapeutic gains 5 years after. We also verified that a significant group of patients who underwent CBGT (13; 62%) started taking antiobsessional medication (p ! 0.001); on the other hand, psychotherapy was given to the patients who had taken sertraline (8; 32%), but at a nonsignificant level (p = 0.084). A total of 10 patients (22%), 2 (9.5%) from the CBGT group and 8 (32%) from the sertraline group, had CBT in the 5-year follow-up period ( 2 = 3.06; p = 0.084). Almost 62% of all patients continued using or started using medication, and 41.5% started or continued undergoing CBT in the 5-year follow-up period. There was a significant increase in remissive patients (partial or full remission) in the sertraline group (p = 0.046); the same did not occur in the CBGT group (p = 0.083). Table 1 shows patients’ scores on the Y-BOCS, CGI, BAI and BDI, as well as the nonimprovement, partial remission, full remission and relapse at the time of the follow-up study. The Y-BOCS total score median rate of variation between the initial treatment trial and the 5-year follow-up in the CBGT group ( fig. 1 ) was a 42.9% increase, while in the sertraline group there was a reduction by 17% (U Wilcoxon-Mann-Whitney = 167.5; p = 0.036). Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRI) are the first-choice treatments for obsessive-compulsive disorder (OCD) [1, 2] . Cognitive-behavioral group therapy (CBGT) has effectiveness similar to one-to-one CBT [3] . Speculation still persists whether the CBT outcomes, and especially CBGT, are sustained in the long term and if there are differences between the outcomes of CBT and antiobsessional medication. The aim of the present study was to investigate whether the reduction in severity of OCD symptoms obtained with 12-weekly sessions of CBGT or with sertraline (100 mg/day) during the same period, in a randomized clinical trial, would be sustained over a 5-year period, as well as to compare the differences between the 2 treatments in the long term. The randomized clinical trial in which patients were treated has been described in detail elsewhere [4] . Forty-six patients (92% of the initial sample) who were treated with CBGT (n = 21; 46%) or sertraline (n = 25; 54%) were evaluReceived: June 25, 2010 Accepted after revision: October 6, 2010 Published online: May 4, 2011

P01-146 - Defense mechanisms changes after cognitive-behavior group therapy plus motivational interviewing and thought mapping for obsessive-compulsive disorder

Objectives Studying defensive styles is typically associated with dynamic theory and therapy. The present study was designed to examine the efficacy of adding two individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM) to cognitive-behavioral group therapy (CBGT) to promote changes in the use of defense mechanisms among obsessive-compulsive disorder (OCD) patients. Methods Forty outpatients meeting OCD DSM-IV criteria were randomly assigned to either a MI+TM group or a control group, before 12 weekly CBGT sessions. To evaluate changes in defense mechanisms, the Defense Style Questionnaire (DSQ) was administered before and after treatment. Results The use of the mature defense mechanisms increased in the MI+TM group at post-treatment, and there were significant differences in the decrease of use of the neurotic defense mechanisms. In addition, patients who achieved full remission differed in the use of the immature defense mechanisms. The control group presented no significant decrease in the use of any defense mechanisms. Conclusions These findings suggest that adding two individual sessions of MI and TM to CBGT can facilitate changes in use of defense mechanisms in OCD adult outpatients, as measured by a specific instrument.