Nirmal Herbst

Mindfulness-based cognitive therapy in obsessive-compulsive disorder - A qualitative study on patients' experiences

BackgroundCognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the first-line treatment for patients with obsessive-compulsive disorder (OCD). However, not all of them achieve remission on a longterm basis. Mindfulness-based cognitive therapy (MBCT) represents a new 8-week group therapy program whose effectiveness has been demonstrated in various mental disorders, but has not yet been applied to patients with OCD.The present pilot study aimed to qualitatively assess the subjective experiences of patients with OCD who participated in MBCT.MethodSemi-structured interviews were conducted with 12 patients suffering from OCD directly after 8 sessions of a weekly MBCT group program. Data were analyzed using a qualitative content analysis.ResultsParticipants valued the treatment as helpful in dealing with their OCD and OCD-related problems. Two thirds of the patients reported a decline in OCD symptoms. Benefits included an increased ability to let unpleasant emotions surface and to live more consciously in the present. However, participants also discussed several problems.ConclusionThe data provide preliminary evidence that patients with OCD find aspects of the current MBCT protocol acceptable and beneficial. The authors suggest to further explore MBCT as a complementary treatment strategy for OCD.

The potential of telemental health applications for obsessive-compulsive disorder

BACKGROUND Only a small percentage of patients with obsessive-compulsive disorder (OCD) receive adequate treatment. Reasons include a high level of shame and stigmatisation and the paucity of specialised treatment services. Telemental health (TMH) treatment could improve the therapeutic situation as has been shown for various mental disorders. This review critically evaluates the current body of evidence on TMH applications for OCD patients. The review focuses on studies that include exposure therapy with response prevention as the best validated treatment component. METHODS Relevant publications were identified through computerised searches of the databases PsycINFO and PubMed and manual searches. No date or study type restrictions were applied. RESULTS Twenty-four studies on different types of TMH applications were identified: bibliotherapy (7), telephone-delivered (11), computer-aided (3), online self-help group (1) and video-conference (2). Nearly all interventions lead to a significant improvement of OC symptoms. Effect sizes ranged from 0.46 to 2.5. CONCLUSIONS Preliminary evidence suggests that TMH applications represent a low-threshold, efficacious, time-effective and economic treatment for patients with OCD. Future studies are needed to further investigate the potential of TMH treatment to improve health care for patients with OCD.

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. Methods A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.

No Talking, Just Writing! Efficacy of an Internet-Based Cognitive Behavioral Therapy with Exposure and Response Prevention in Obsessive Compulsive Disorder

Background: Many patients with obsessive-compulsive disorder (OCD) do not receive first-line treatment according to the current guidelines (cognitive behavioral therapy with exposure and response prevention, CBT with ERP) due to barriers to treatment. Internet-based therapy is designed to overcome these barriers. The present study evaluates the efficacy of an Internet-based writing therapy with therapeutic interaction based on the concept of CBT with ERP for patients with OCD. Methods: Thirty-four volunteers with OCD according to DSM-IV-criteria were included in the trial and randomized according to a waiting-list control design with follow-up measures at 8 weeks and 6 months. The intervention consisted of 14 sessions, either starting directly after randomization or with an 8-week delay. Main outcome measure was the change in the severity of OCD symptoms (Yale-Brown Obsessive Compulsive Scale Self-Rating, Y-BOCS SR, and Obsessive-Compulsive Inventory-Revised, OCI-R). Results: Obsessive-compulsive symptoms were significantly improved in the treatment group compared to the waiting-list control group with large effect sizes of Cohens d = 0.82 (Y-BOCS SR) and d = 0.87 (OCI-R), using an intention-to-treat analysis. This effect remained stable at 6-month follow-up. Only 4 participants (12%) dropped out prematurely from the study. Of the 30 completers, 90% rated their condition as improved and would recommend the program to their friends. Conclusions: Internet-based writing therapy led to a significant improvement of obsessive-compulsive symptoms. Even though replications with larger sample sizes are needed, the results support the notion that Internet-based approaches have the potential for improving the treatment situation for patients with OCD.

The Effect of Personality Disorders on Treatment Outcomes in Patients With Obsessive-Compulsive Disorders

The effect of comorbid personality disorders (PD) on treatment outcomes in obsessive-compulsive disorder (OCD) is unclear. The authors systematically review results from investigations of therapy outcomes in adult patients with OCD and a comorbid PD. PsycINFO and MEDLINE were searched for original articles. Twenty-three studies assessing PDs through interviews were selected. Cluster A PDs, particularly schizotypal PD, narcissistic PD, and the presence of two or more comorbid PDs, were associated with poorer treatment outcomes in patients with OCD. With regard to other PDs and clusters, the results are inconsistent or the sample sizes are too small to reach a conclusion. OCD patients with different comorbid PDs differ in their therapeutic response to treatment. To optimize the treatment of OCD, the predictive value of PDs on the treatment outcome should be further investigated, and treatment of Axis I and II comorbidity requires more attention.

Quality of life changes following inpatient and outpatient treatment in obsessive-compulsive disorder: a study with 12 months follow-up

BackgroundQuality of life (QoL) is increasingly recognized as a critical outcome parameter in mental health studies. The aim of this study was to investigate different domains of the QoL in persons with obsessive-compulsive disorder (OCD) before and after a multimodal, disorder-specific in- and outpatient treatment.MethodsData of 73 persons with OCD treated in an inpatient setting followed by outpatient treatment were analyzed. The World Health Organization Quality of Life abbreviated (a multidimensional measure of the QoL) and the Beck Depression Inventory were administered prior to (baseline) and 12 months after the inpatient treatment (follow-up).ResultsAt baseline, participants reported a significantly diminished psychological, social, physical, and global QoL compared to the German general population. Environmental QoL was not impaired in the present sample. The QoL was significantly improved at follow-up, except for social QoL, but remained below norm values. The QoL improvement was predicted by improvements of depressive symptoms.ConclusionsThe results indicate that persons with OCD suffer from a very low QoL. The QoL was significantly improved after 12 months of intensive state-of-the-art treatment. However, the QoL indices remained considerably lower than population norm values, indicating the need for additional research into novel treatment options for persons with OCD.

Welche Funktionen erfüllen Zwangssymptome? – Ergebnisse einer Analyse im stationären Setting

Einleitung: Zwangssymptome kÖnnen verschiedene intrapsychische und interpersonelle FunktionalitÄten, d.h. unterschiedliche ZweckmÄßigkeiten oder Sinnhaftigkeiten fÜr den Betroffenen besitzen, die bei einer erfolgreichen Psychotherapie berÜcksichtigt werden sollten. Die vorliegende Studie verfolgte das Ziel, erstmals anhand einer Stichprobe stationÄrer Patienten die im Rahmen kognitiver Verhaltenstherapie erarbeiteten FunktionalitÄten systematisch zu erfassen und auf ZusammenhÄnge mit soziodemografischen und klinischen Variablen hin zu untersuchen. Material und Methoden: Die Behandlungsberichte aller von 2001–2008 stationÄr in unserem Hause behandelten Patienten mit der Erstdiagnose ZwangsstÖrung wurden in die Erhebung aufgenommen. 168 Berichte (63%) enthielten explizite Angaben Über die jeweiligen FunktionalitÄten der StÖrung, welche mittels qualitativer Inhaltsanalyse unter deduktiver Kategorienbildung systematisch ausgewertet wurden. Die erhobenen Funktionen wurden auf ZusammenhÄnge mit Alter, Geschlecht, Erkrankungs- und Behandlungsdauer untersucht. Ergebnis: Bei mehr als der HÄlfte der Patienten (57,7%) waren ≥2 FunktionalitÄten vertreten; insgesamt wurde den ZwÄngen etwas hÄufiger eine intrapsychische FunktionalitÄt zugeschrieben als eine interpersonelle. Am hÄufigsten (53,7%) dienten ZwÄnge der Emotionsregulation; der Wunsch nach Autonomie und Abgrenzung stellte die hÄufigste interpersonelle FunktionalitÄt dar (42,1%). Keine der gefundenen 11 FunktionalitÄten war mit lÄngerer Erkrankungsdauer oder hÄufigeren BehandlungsabbrÜchen assoziiert. Allerdings ließen sich ZusammenhÄnge zwischen einzelnen Subgruppen von Zwangssymptomen und bestimmten FunktionalitÄten feststellen. Schlussfolgerung: Die Ergebnisse verweisen auf eine große Bandbreite an FunktionalitÄten, wobei dem BedÜrfnis nach Regulation aversiver Emotionen und Autonomie ein besonderer Stellenwert zukommt.

The prediction of treatment outcomes by early maladaptive schemas and schema modes in obsessive-compulsive disorder

BackgroundHigher levels of early maladaptive schemas (EMS) and schema modes according to schematherapy by Jeffrey Young are present in obsessive-compulsive disorder (OCD) compared to healthy controls. This study examines the relationship of EMS and schema modes to OC symptom severity and the predictive value of EMS and schema modes on treatment outcome in inpatients receiving Cognitive-Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). The main assumption was a negative association between the EMS of the domain ‘disconnection’ and dysfunctional coping and parent schema modes and the treatment outcome.MethodsEMS, schema modes, depression and traumatic childhood experiences were measured in 70 patients with OCD. To analyze the predictors, two regression analyses were conducted considering multiple variables, such as depression, as covariates.ResultsRegression analyses demonstrated that higher scores on the EMS named failure and emotional inhibition and depressive symptom severity at pretreatment were significantly related to poor outcome and explained a high percentage of the variance in OC symptoms at posttreatment. No influence on the treatment outcome was observed for schema modes, other EMS or other covariates.ConclusionsThe results support the approach to extend the CBT with ERP treatment with therapeutic elements focusing on maladaptive schemas, particularly in non-responders.

Prävention psychischer und psychosomatischer Störungen in der gesundheitspolitischen Diskussion

Wir haben einen Hype in der medialen Aufbereitung von Themen, die sich um Arbeitswelt, Burnout und psychische Erkrankung gruppieren. Die direkte kausale Verbindung von psychosozialen Belastungen in der modernen Arbeitswelt und daraus sich entwickelnden Gesundheitsgefährdungen ist für Laien überzeugend; die Diskussion aber wird nicht selten der Komplexität des Bedingungsgefüges von objektiven Arbeitsbelastungen, Persönlichkeit und individuellen biologischen und psychosozialen Vulnerabilitäten nicht gerecht. Dennoch gibt es genügend empirische Evidenz dafür, dass wir eine überproportionale ProduktivitätssteiWas war der Hintergrund der Gründung eines Kompetenzzentrums zur Prävention psychischer und psychosomatischer Störungen in der Arbeitsund Ausbildungswelt (PPAA)?