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Empirically Grounded Clinical Interventions: Cognitive Versus Behaviour Therapy in the Individual Treatment of Obsessive-Compulsive Disorder: Changes in Cognitions and Clinically Significant Outcomes at Post-Treatment and One-Year Follow-Up

Published online by Cambridge University Press:  19 June 2008

Amparo Belloch ,
Elena Cabedo  and
Carmen Carrió
Amparo Belloch*
Affiliation:
University of Valencia, Spain
Elena Cabedo
Affiliation:
Agencia Valenciana de Salud, Spain
Carmen Carrió
Affiliation:
Diputacion de Valencia, Spain
*
Reprint requests to Amparo Belloch, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Avenida Blasco Ibáñez, 21 Valencia 46010, España. E-mail: amparo.belloch@uv.es
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Abstract

Clinical significance analyses of controlled studies comparing Exposure and Response Prevention (ERP) and Cognitive Therapy (CT) in the treatment of Obsessive-Compulsive Disorder (OCD) are scarce. The objective of this study is to compare the clinical efficacy of ERP and CT for OCD patients, and the usefulness of each in changing dysfunctional beliefs and thought control strategies at post-treatment and at a one-year follow-up. The two treatments were delivered on the basis of a routine clinical practice in a public-mental health service. Thirty-three OCD patients were randomly assigned to ERP or CT, and 29 completed the treatments (13 in ERP and 16 in CT). The ERP applied was in vivo, gradual and therapist-guided. The CT was designed to challenge all the cognitive domains considered relevant for OCD, using cognitive techniques. The improvement and recovery rates (YBOCS) were slightly superior for CT than for ERP (ERP: 69.23% and 61.53%, respectively; CT: 81.25% and 68.75%, respectively). These therapeutic outcomes were maintained after the two treatments: at the one-year follow-up, 53.85% of the treated patients remained free of symptoms in ERP, and 65.5% in CT. Finally, the two treatments were equally effective in modifying dysfunctional beliefs, and the outcomes at the end of the treatments were maintained, or even increased, one year later.

Keywords

Obsessive-Compulsive DisorderExposure and Response Preventioncognitive therapydysfunctional beliefs
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 5 , October 2008 , pp. 521 - 540
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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References

Abramowitz, J. S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology, 65, 44–52.CrossRefGoogle ScholarPubMed
Abramowitz, J. S. (1998). Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance. Behavior Therapy, 29, 339–335.CrossRefGoogle Scholar
Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51, 407–416.CrossRefGoogle ScholarPubMed
Abramowitz, J., Foa, E. B. and Franklin, M. E. (2003). Exposure and ritual prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions. Journal of Consulting and Clinical Psychology, 71, 394–398.CrossRefGoogle ScholarPubMed
Abramowitz, J., Franklin, M. E. and Foa, E. B. (2002). Empirical status of cognitive behavioral therapy for obsessive-compulsive disorder. Romanian Journal of Cognitive Behavioral Therapy, 2, 89–104.Google Scholar
Abramowitz, J. S., Whiteside, S., Kalsy, S. A. and Tolin, D. F. (2003). Thought control strategies in obsessive-compulsive disorder: a replication and extension. Behaviour Research and Therapy, 41, 529–540.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: APA.Google Scholar
Beck, A. T., Rush, A. J., Shaw, B. F. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, A. T., Steer, R. A. and Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.CrossRefGoogle Scholar
Becker, B. J. (1988). Synthesizing standardized mean-change measures. British Journal of Mathematical and Statistical Psychology, 41, 257–278CrossRefGoogle Scholar
Belloch, A. and Baños, R. (1990). Validación del inventario de pensamientos automáticos negativos (ATQ) para su uso en población española (Spanish validation of the Automatic Thoughts Questionnaire) Experimental Edition. Personality Psychology Department, University of Valencia (Spain).Google Scholar
Belloch, A., Cabedo, E., Morillo, C., Lucero, M. and Carrió, C. (2003). Diseño de un instrumento para evaluar las creencias disfuncionales del trastorno obsesivo-compulsivo: resultados preliminares del Inventario de Creencias Obsesivas (ICO). (Design of an instrument to assess dysfunctional beliefs in Obsessive-Compulsive Disorder: preliminary results of the Obsessional Beliefs Inventory). International Journal of Clinical and Health Psychology, 3, 235–250.Google Scholar
Belloch, A., Morillo, C. and Garcia-Soriano, G. in press. Strategies to control unwanted intrusive thoughts: which are relevant and specific in obsessive-compulsive disorder? Cognitive Therapy and Research. DOI 10.1007/s10608-007-9141–2.Google Scholar
Belloch, A., Morillo, C., Luciano, J. V., García-Soriano, G., Cabedo, E. and Carrió, C. (2008). Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity. Manuscript submitted for publication.Google Scholar
Burns, G. L., Keortge, S. G., Formea, G. M. and Sternberg, L. G. (1996). Revision of the Padua inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions. Behaviour Research and Therapy, 34, 163–173.CrossRefGoogle ScholarPubMed
Cabedo, E., Belloch, A., Morillo, C., Giménez, A. and Carrió, C. (2004). Intensidad de las creencias disfuncionales en relación con el incremento en obsesividad (Increased self-adscription of dysfunctional beliefs as the obsessional tendencies increases). International Journal of Clinical and Health Psychology, 4, 465–479Google Scholar
Clark, D. A. (2004). Cognitive-Behavioral Therapy for OCD. New York: The Guilford Press.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.) Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Cottraux, J., Note, I., Nan Yao, S., Lafont, S., Note, B., Mollard, E., Bouvard, M., Sauteraud, A., Bourgeois, M. and Dartigues, J. F. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 70, 288–297.CrossRefGoogle ScholarPubMed
Di Nardo, P. A., Brown, T. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: lifetime version (ADIS-IV-L). New York: Graywind Publications Inc.Google Scholar
Eddy, K. T., Dutra, L., Bradley, R. and Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24, 1011–1030.CrossRefGoogle ScholarPubMed
Emmelkamp, P. M. and Beens, H. (1991). Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation. Behaviour Research and Therapy, 29, 293–300.CrossRefGoogle ScholarPubMed
Emmelkamp, P. M. and Foa, E. B. (1983). Failures are a change. In Foa, E. B. and Emmelkamp, P. M. (Eds.), Failures in Behavior Therapy (pp. 1–9). New York: Wiley.Google Scholar
Emmelkamp, P. M., van Oppen, P. and van Balkom, A. J. L. M. (2002). Cognitive changes in patients with obsessive-compulsive rituals treated with exposure in vivo and response prevention. In Frost, R. O. and Steketee, G. (Eds.), Cognitive Approaches to Obsessions and Compulsions: theory, assessment and treatment (pp. 391–401). Oxford: Elsevier Science.CrossRefGoogle Scholar
Emmelkamp, P. M., Visser, S. and Hoekstra, R. J. (1988). Cognitive therapy versus exposure in vivo in the treatment of obsessive-compulsives. Cognitive Therapy and Research, 12, 103–114.CrossRefGoogle Scholar
Fisher, P. L. and Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significant analysis. Behaviour Research and Therapy, 43, 1543–1558.CrossRefGoogle Scholar
Foa, E. B., Franklin, M. E. and Kozak, M. J. (1998). Psychosocial treatments for obsessive-compulsive disorder: literature review. In Swinson, R. P., Antony, M. M., Rachman, S. and Richter, M. A. (Eds.), Obsessive-Compulsive Disorder: theory, research and treatment (pp. 258–276). New York: Guilford Press.Google Scholar
Foa, E. B. and Kozak, M. J. (1996). Psychological treatments for obsessive-compulsive disorder. In Mavissakalian, M. R. and Prien, R. F. (Eds.), Long-term Treatments of Anxiety Disorders (pp. 285–309). Washington, DC: American Psychiatric Press.Google Scholar
Franklin, M. E., Abramowitz, J. S., Kozak, M. J., Lewitt, J. T. and Foa, E. B. (2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68, 594–602.CrossRefGoogle ScholarPubMed
Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rhèaume, J., Letarte, H. and Bujold, A. (1997). Cognitive-behavioral treatment of obsessive thoughts: a controlled study. Journal of Consulting and Clinical Psychology, 65, 405–413.CrossRefGoogle ScholarPubMed
Freeston, M. H., Ladouceur, R., Rhéaume, J. and Léger, E. (1998). Applications of cognitive models of OCD in clinical practice. In Sanavio, E. (Ed.), Behavior and Cognitive Therapy Today: essays in honour of Hans J. Eysenck (pp.117–127). Oxford: Elsevier Science.CrossRefGoogle Scholar
Freeston, M. H., Léger, E. and Ladouceur, R. (2001). Cognitive therapy of obsessive thoughts. Cognitive and Behavioral Practice, 8, 61–78.CrossRefGoogle Scholar
Freeston, M. H., Rhéaume, J. and Ladouceur, R. (1996). Correcting faulty appraisals of obsessional thoughts. Behaviour Research and Therapy, 34, 433–446.CrossRefGoogle ScholarPubMed
Giménez, A., Morillo, C., Belloch, A., Carrió, C. and Cabedo, E. (2004). Creencias disfuncionales asociadas a síntomas obsesivo-compulsivos: una aproximación a la especificidad (Dysfunctional beliefs and obsessive-compulsive symptoms: an approach to the specificity). Revista de Psicopatología y Psicología Clínica, 9, 1–17.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishman, R. J., Hill, C. L., Heninger, G. R. and Charney, D. S. (1989a). The Yale-Brown Obsessive-Compulsive Scale (I): development, use and reliability. Archives of General Psychiatry, 46, 1006–1011.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Ramussen, S. A., Mazure, C., Delgado, F., Heninger, G. R. and Charney, D. S. (1989)b. The Yale-Brown Obsessive-Compulsive Scale (II): validity. Archives of General Psychiatry, 46, 1012–1016.CrossRefGoogle Scholar
Hollon, S. D. and Kendall, P. C. (1980). Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4, 383–395.CrossRefGoogle Scholar
Ibáñez, I., Olmedo, E., Peñate, W. and González, M. (2002). Obsesiones y compulsiones: estructura del Inventario de Padua (Obsessions and compulsions: structure of the Padua Inventory). Revista Internacional de Psicología Clinica y de la Salud, 2, 263–288.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Kozak, M. J. and Foa, E. B. (1997). Mastery of Obsessive-Compulsive Disorder: a cognitive-behavioral approach. San Antonio: Psychological Corp.Google Scholar
Kozak, M. J., Liebowitz, M. and Foa, E. B. (2000). Cognitive behaviour therapy and pharmacotherapy for obsessive-compulsive disorder: the NIMH-sponsored collaborative study. In Goodman, W. K., Rudorfer, M. V. and Maser, J. D. (Eds.), Obsessive-Compulsive Disorder: contemporary issues in treatment (pp. 501–530). Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Ladouceur, R., Freeston, M. H., Gagnon, F., Thiboudeau, N. and Dumont, J. (1995). Cognitive-behavioral treatment of obsessions. Behaviour Modification, 19, 247–257.CrossRefGoogle ScholarPubMed
Ladouceur, R., Léger, E., Rhéaume, J. and Dubé, D. (1996). Correction of inflated responsibility in the treatment of obsessive-compulsive disorder. Behaviour Research and Therapy, 34, 767–774.CrossRefGoogle ScholarPubMed
Longmore, R. J. and Worrell, M. (2006). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, doi:10.1016/ j.cpr.2006.08.001.Google Scholar
Luciano, J. V., Belloch, A., Algarabel, S., Tomás, J. M., Morillo, C. and Lucero, M. (2006). Confirmatory factor analysis of the White Bear Suppression Inventory and the Thought Control Questionnaire: a comparison of alternative models. European Journal of Psychological Assessment, 22, 250–258.CrossRefGoogle Scholar
Luciano, J. V., Morillo, C., García-Soriano, G. and Belloch, A. (2006). Confirmatory Factor Analysis of the Spanish Obsessive Beliefs Inventory-Revised. Poster presented at the 36th Annual Congress of the EABCT, Paris, September.Google Scholar
McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S., Söchting, I., Koch, W. J., Paterson, R. and Anderson, K. W. (2001). Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 69, 205–214.CrossRefGoogle Scholar
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 987–1006.CrossRefGoogle Scholar
Purdon, C. and Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology and Psychotherapy, 6, 102–110.3.0.CO;2-5>CrossRefGoogle Scholar
Rachman, S. J. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.CrossRefGoogle ScholarPubMed
Rachman, S. J. (1998). A cognitive theory of obsessions: elaborations. Behaviour Research and Therapy, 36, 385–401.CrossRefGoogle Scholar
Rachman, S. J. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40, 625–639.CrossRefGoogle ScholarPubMed
Rachman, S. J. (2003). The Treatment of Obsessions. Oxford: Oxford University Press.CrossRefGoogle Scholar
Reynolds, M. and Wells, A. (1999). The Thought Control Questionnaire: psychometric properties in a clinical sample, and relationships with PTSD and depression. Psychological Medicine, 29, 1089–1099.CrossRefGoogle Scholar
Sanavio, E. (1988). Obsessions and compulsions: the Padua Inventory. Behaviour Research and Therapy, 26, 167–177.CrossRefGoogle ScholarPubMed
Sandín, B. and Chorot, P. (1991). Adaptación española del Penn State Worry Questionnaire (Penn State Worry Questionnaire: adaptation to Spanish). Madrid: UNED.Google Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 149–160.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1996). Cognitive-behavioral approaches to the understanding of obsessional problems. In: Rapee, R. (Ed.), Current Controversies in the Anxiety Disorders (pp. 103–133). New York: Guilford.Google Scholar
Salkovskis, P. M. (1999). Understanding and treating OCD. Behaviour Research and Therapy, 37 (Special suppl.), 529–552.CrossRefGoogle Scholar
Salkovskis, P. M. and Warwick, H. C. (1985). Cognitive therapy of obsessive-compulsive disorder: treating treatment failures. Behavioural Psychotherapy, 13, 243–255.CrossRefGoogle Scholar
Salkovskis, P. M. and Warwick, H. C. (1988). Cognitive therapy of obsessive-compulsive disorder. In Perris, C., Blackburn, I. M. and Perris, H., Cognitive Psychotherapy: theory and practice (pp. 376–395). Berlin: Springer Verlag.CrossRefGoogle Scholar
Salkovskis, P. M. and Westbrook, D. (1989). Behavior therapy and obsessional ruminations: can failure be turned into success? Behaviour Research and Therapy, 27, 149–160.CrossRefGoogle Scholar
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M. and Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive-compulsive disorders. Behaviour Research and Therapy, 38, 347–372.CrossRefGoogle Scholar
Sanavio, E. (1988). Obsessions and compulsions: the Padua Inventory. Behaviour Research and Therapy, 26, 167–177.CrossRefGoogle Scholar
Sanz, J. and Vazquez, C. (1998). Fiabilidad, validez y datos normativos del Inventario para la Depresion de Beck (Reliability, validity and normative data of the Beck Depression Inventory). Psicothema, 10, 303–318.Google Scholar
Seisdedos, N. (1988). Cuestionario de Ansiedad Estado-Rasgo. Adaptación española. (State-Trait Anxiety Inventory: Spanish adaptation). Madrid: TEA.Google Scholar
Shafran, R., Thordarson, D. S. and Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10, 379–391.CrossRefGoogle Scholar
Spielberger, C. D., Gorsuch, R. L. and Lushene, R. E. (1970). STAI, Manual for the State-Trait Anxiety Inventory (Self evaluation questionnaire). Palo Alto, Ca: Consulting Psychologist Press.Google Scholar
Steketee, G. (1993). Treatment of Obsessive-Compulsive Disorder. New York: Guilford.Google Scholar
Steketee, G. (1999). Overcoming Obsessive-Compulsive Disorder: a behavioural and cognitive protocol for the treatment of OCD. Oakland, CA: New Harbinger.Google Scholar
van Balkom, A. J. L. M., de Haan, E., van Oppen, P., Spinhoven, P., Hoogduin, K. A. L. and van Dyck, R. (1998). Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive-compulsive disorder. Journal of Nervous and Mental Disease, 186, 492–499.CrossRefGoogle ScholarPubMed
van Oppen, P. and Arntz, A. (1994). Cognitive therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 79–87.CrossRefGoogle ScholarPubMed
van Oppen, P., De Haan, E., van Balkom, A. J., Spinhoven, P., Hoogduin, K. and van Dick, R. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behaviour Research and Therapy, 33, 379–390.CrossRefGoogle ScholarPubMed
Wegner, D. M. and Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615–640.CrossRefGoogle ScholarPubMed
Wells, A. and Davies, M. I. (1994). The Thought Control Questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy, 32, 871–878.CrossRefGoogle ScholarPubMed
Whittal, M. L. and McLean, P. D. (2002). Group cognitive behavioural therapy for obsessive-compulsive disorder. In Frost, R. O. and Steketee, G. (Eds.), Cognitive Approaches to Obsessions and Compulsions: theory, assessment and treatment (pp. 417–433). Oxford: Elsevier Science.CrossRefGoogle Scholar
Whittal, M. L., Thordarson, D. S. and McLean, P. D. (2005). Treatment of obsessive-compulsive disorder: cognitive behavior therapy versus exposure and response prevention. Behaviour Research and Therapy, 43, 1559–1576.CrossRefGoogle Scholar
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