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Outcome of Intensive Cognitive Behaviour Therapy in a Residential Setting for People with Severe Obsessive Compulsive Disorder: A Large Open Case Series

Published online by Cambridge University Press:  30 June 2015

David Veale Open the ORCID record for David Veale [Opens in a new window] ,
Iona Naismith ,
Sarah Miles ,
Grace Childs ,
Jack Ball ,
Francesca Muccio  and
Simon Darnley
David Veale*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, and the Bethlem Royal Hospital, Beckenham, UK
Iona Naismith
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, and the Bethlem Royal Hospital, Beckenham, UK
Sarah Miles
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Grace Childs
Affiliation:
The Bethlem Royal Hospital, Beckenham, UK
Jack Ball
Affiliation:
The Bethlem Royal Hospital, Beckenham, UK
Francesca Muccio
Affiliation:
The Bethlem Royal Hospital, Beckenham, UK
Simon Darnley
Affiliation:
The Bethlem Royal Hospital, Beckenham, UK
*
Reprint requests to David Veale, The Anxiety Disorders Residential Unit, Dower House, The Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK. E-mail: [email protected]
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Abstract

Background: There is little data to inform the treatment of severe obsessive compulsive disorder (OCD) in an inpatient or residential setting. Aims: This paper aimed to: a) describe treatment outcomes at a residential unit over 11 years; b) investigate whether treatment was successful for a subset of severe treatment refractory residents; c) compare an intensive treatment programme to a “standard” treatment programme; and d) find predictors of self or early discharge from the unit. Method: We compared treatment outcomes for (i) a minimum 12-week treatment (hereafter “standard”) programme versus a 2-week intensive programme and (ii) for severe treatment refractory cases on the standard programme. We identified 472 residents with OCD admitted to the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital between 2001 and 2012. Outcomes were measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Compulsive Inventory (OCI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) obtained throughout treatment and up to one year after discharge. Results: Although residents had very severe OCD on admission, sequential assessment with the Y-BOCS, OCI, BAI and BDI demonstrated that scores on all outcome measures significantly decreased from pre to posttreatment and were generally maintained at follow-up. There was no significant difference between those on the standard or the 2-week intensive programme. Sixty-nine per cent of residents with OCD made significant improvements, with at least a 25% reduction on the Y-BOCS. There were predictors of self or early discharge but none for outcome on the Y-BOCS. Conclusions: The data support the principle of stepped care for severe OCD.

Keywords

Obsessive-compulsive disorder (OCD)outcomeinpatientresidential unitcognitive behaviour therapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 3 , May 2016 , pp. 331 - 346
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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References

Adams, T. G., Jr., Riemann, B. C., Wetterneck, C. T. and Cisler, J. M. (2012). Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder. Cognitive Behaviour Therapy, 41, 203–211.Google Scholar
Beck, A. T. (1993). Beck Depression Inventory Manual. San Antonio: The Psychological Corporation.Google Scholar
Beck, A. T. and Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio: The Psychological Corporation.Google Scholar
Bjorgvinsson, T., Wetterneck, C. T., Powell, D. M., Chasson, G. S., Webb, S. A., Hart, J., et al. (2008). Treatment outcome for adolescent obsessive-compulsive disorder in a specialized hospital setting. Journal of Psychiatric Practice, 14, 137–145.CrossRefGoogle Scholar
Boschen, M. J., Drummond, L. M., Pillay, A. and Morton, K. (2010). Predicting outcome of treatment for severe, treatment resistant OCD in inpatient and community settings. Journal of Behavior Therapy and Experimental Psychiatry, 41, 90–95.Google Scholar
Castle, D. J., Deale, A., Marks, I. M. and Cutts, F. (1994). Obsessive-compulsive disorder: prediction of outcome from behavioural psychotherapy. Acta Psychiatrica Scandinavica, 89, 393–398.CrossRefGoogle ScholarPubMed
Drummond, L. M., Fineberg, N. A., Heyman, I., Kolb, P., Pillay, A., Rani, S., et al. (2008). The development of a National Service for adolescents and adults with the most severe, refractory obsessive-compulsive and body dysmorphic disorder. Psychiatric Bulletin, 32, 333–336.CrossRefGoogle Scholar
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV axis I Disorders. New York: Biometric Research Department.Google Scholar
Fisher, P. L. and Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis. Behavior Research and Therapy: An International Multi-Disciplinary Journal, 43, 1543–1558.Google Scholar
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: the Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206–214.Google Scholar
Gilbert, P. and Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13, 353–379.Google Scholar
Gonner, S., Limbacher, K. and Ecker, W. (2012). Inpatient cognitive behavior therapy for obsessive-compulsive disorder: effectiveness and predictors of response in routine clinical practice. Verhaltenstherapie, 22, 17–26.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A. and Mazure, C. (1989). The Yale-Brown Obsessive Compulsive Scale: I. development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.CrossRefGoogle ScholarPubMed
Hollander, E., Stein, D. J., Fineberg, N. A., Marteau, F. and Legault, M. (2010). Quality of life outcomes in patients with obsessive-compulsive disorder: relationship to treatment response and symptom relapse. The Journal of Clinical Psychiatry, 71, 784–792.Google Scholar
Knopp, J., Knowles, S., Bee, P., Lovell, K. and Bower, P. (2013). A systematic review of predictors and moderators in response to psychological therapies in OCD: do we have enough empirical evidence to target treatment? . Clinical Psychology Review, 33, 1067–1081.Google Scholar
Langner, J., Laws, M., Roeper, G., Zaudig, M., Hauke, W. and Piesbergen, C. (2009). Predicting therapy outcome in patients with early and late obsessive-compulsive disorder (EOCD and LOCD). Behavioural and Cognitive Psychotherapy, 37, 485–496.CrossRefGoogle ScholarPubMed
McKenzie, N. and Marks, I. (2003). Routine monitoring of outcome over 11 years in a residential behavioural psychotherapy unit. Psychotherapy and Psychosomatics, 72, 223–227.Google Scholar
National Collaborating Centre for Mental Health (NCCMH) (2006). Obsessive Compulsive Disorder: core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder. London: Gaskell and BPS.Google Scholar
Oldfield, V. B., Salkovskis, P. M. and Taylor, T. (2011). Time-intensive cognitive behaviour therapy for obsessive-compulsive disorder: a case series and matched comparison group. British Journal of Clinical Psychology, 50, 7–18.Google Scholar
Pallanti, S., Hollander, E., Bienstock, C., Koran, L., Leckman, J., Marazziti, D., et al. (2002). Treatment non-response in OCD: methodological issues and operational definitions. International Journal of Neuropsychopharmacology, 5, 181–191.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1999). Understanding and treating obsessive compulsive disorder. Behaviour Research and Therapy, 37, S29–S52.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Richards, C. and Forrester, E. (2000). Psychological treatment of refractory obsessive-compulsive disorder and related problems. In Goodman, W. K., Rudorfer, M. and Maser, J. D. (Eds), Obsessive-Compulsive Disorder: contemporaty issues in treatment. (pp. 201–221). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Stewart, S., Stack, D. E., Farrell, C., Pauls, D. L. and Jenike, M. A. (2005). Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder. Journal of Psychiatric Research, 39, 603–609.CrossRefGoogle ScholarPubMed
Stewart, S., Stack, D. E., Tsilker, S., Alosso, J., Stephansky, M., Hezel, D. M., et al. (2009). Long-term outcome following intensive residential treatment of obsessive-compulsive disorder. Journal of Psychiatric Research, 43, 1118–1123.CrossRefGoogle ScholarPubMed
Veale, D., Gilbert, P., Wheatley, J. and Naismith, I. (2014). A new therapeutic community: development of a compassion-focussed and contextual behavioural environment. Clinical Psychology & Psychotherapy. Accessed on 14 April 2014, http://dx.doi.org/10.1002/cpp.1897 Google Scholar
White, I. R., Royston, P. and Wood, A. M. (2011). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine, 30, 377–399.Google Scholar
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