Does cognitive-behavioral therapy response among adults with obsessive–compulsive disorder differ as a function of certain comorbidities?
Section snippets
Participants
One hundred and forty-three patients (male = 68, female = 75) participated in this study across two sites. Enrollment sites included two university-based OCD specialty centers, one in the Southeastern United States and the other in South East Queensland, Australia. Demographic variables (i.e., age, gender, ethnicity) and clinical dimensions (i.e., symptom severity, comorbidity) did not differ across recruitment sites. Inclusion criteria required that subjects have a current primary diagnosis of OCD
Preliminary analyses
The overall sample consisted of 143 patients, 98 (69%) of who met criteria for at least one comorbid psychiatric disorder. Comorbid diagnoses included: GAD (n = 54; 38%), MDD (n = 44; 31%), social phobia (SP; n = 42; 30%), and panic disorder (PD; n = 24; 17%). Other comorbid conditions were present in varying degrees (e.g., PTSD; specific phobia; tic disorders) but not included in analyses given their low frequency. In addition to OCD, participants met criteria for an average of 1.1 (SD = 1.0) additional
Discussion
While CBT is indicated as the first line treatment of choice for OCD, more information is needed about how comorbid diagnoses might impact outcome. Previous studies have examined the impact of depressive disorders on response rates (e.g., Abramowitz et al., 2000); however, little data exists on symptom remission, which is considered a practical indicator of change that corresponds with improved quality of life (Huppert, Simpson, Nissenson, Liebowitz, & Foa, 2009). The present study extends the
References (59)
- et al.
Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD?
Behavior Therapy
(2000) - et al.
Effects of comorbid depression on response to treatment for obsessive–compulsive disorder
Behavior Therapy
(2000) - et al.
The effectiveness of treatment for pediatric obsessive–compulsive disorder: A meta-analysis
Behavior Therapy
(2005) - et al.
The relationship of obsessive–compulsive disorder to possible spectrum disorders: Results from a family study
Biological Psychiatry
(2000) - et al.
Comorbidity for obsessive–compulsive disorder in bipolar and unipolar disorders
Psychiatry Research
(1995) - et al.
A method of assessing change in a single subject: An alteration of the RC index
Behaviour Therapy
(1986) - et al.
Behavior therapy for obsessive compulsive disorder
Psychiatric Clinics of North America
(1992) - et al.
Personality disorders do not influence the results of cognitive and behavior therapy for obsessive–compulsive disorder
Journal of Anxiety Disorders
(1997) - et al.
A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive–compulsive disorder
Clinical Psychology Review
(2004) - et al.
How effective are cognitive and behavioral treatments for obsessive-compulsive disorder? A clinical significance analysis
Behaviour Research and Therapy
(2005)
Assessment of severity and change in obsessive compulsive disorder
Psychiatric Clinics of North America
Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance
Behaviour Therapy
Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder
Clinical Psychology Review
DSM-III personality disorders in obsessive–compulsive disorders: Changes with treatment
Comprehensive Psychiatry
Schizotypal personality disorder: A poor prognostic indicator for behavior therapy in the treatment of obsessive–compulsive disorder
Journal of Anxiety Disorders
Clinical obsessions in obsessive–compulsive patients and obsession-relevant intrustive thoughts in non-clinical, depressed and anxious subjects: Where are the differences?
Behaviour Research and Therapy
Effects of axis I and II comorbidity on behavior therapy outcome for obsessive–compulsive disorder and agoraphobia
Comprehensive Psychiatry
Predictors of course in obsessive–compulsive disorder
Psychiatric Research
The impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive compulsive disorder
Journal of the American Academy of Child and Adolescent Psychiatry
Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale
Behaviour Research and Therapy
Nosological insertion of axis I disorders in the etiology of obsessive–compulsive disorder
Journal of Anxiety Disorders
Effectiveness of psychological and pharmacological treatments for obsessive–compulsive disorder: A quantitative review
Journal of Consulting and Clinical Psychology
Obsessive–compulsive patients with comorbid personality disorder: Associated problems and response to a comprehensive behavior therapy
Journal of Clinical Psychiatry
Effect of axis II diagnosis on treatment outcome with clomipramine in 55 patients with obsessive–compulsive disorder
Archives of General Psychiatry
Cognitive-behavioral family treatment of childhood obsessive–compulsive disorder: A controlled trial
Journal of the American Academy of Child and Adolescent Psychiatry
Sertraline and fluoxetine treatment of obsessive–compulsive disorder: Results of a double-blind, 6-month treatment study
Journal of Clinical Psychopharmacology
Treatment outcome for adolescent obsessive–compulsive disorder in a specialized hospital setting
Journal of Psychiatric Practice
Anxiety Disorders Interview Schedule Adult Version (ADIS-IV): Client interview schedule
Tourette's disorder with and without obsessive–compulsive disorder in adults: Are they different?
Journal of Nervous and Mental Disease
Cited by (32)
Psychiatric Comorbidity Populations
2022, Comprehensive Clinical Psychology, Second EditionThe effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder
2014, Journal of Affective DisordersCitation Excerpt :Similarly, the current results are consistent with the findings of a large randomized controlled trial (N=1004) which showed that although comorbid depression was associated with starting and ending treatment with more severe anxiety symptoms in a sample of individuals with mixed anxiety disorders2, co-occurring depression did not interfere with the magnitude of gains from computerized CBT, medication management, or both (Campbell-Sills et al., 2012). The present findings are also in agreement with the results of previous studies on the impact of comorbid depression on CBT for panic disorder (Allen et al., 2010) and obsessive–compulsive disorder (Storch et al., 2010), which found that comorbid depression did not interfere with anxiety symptom reduction. Further, our results are in line with those of Bowen and D׳Arcy (2003), who found that in a sample of individuals with panic disorder, hypomanic symptoms did not have a negative effect on response to CBT.
Cognitive functioning in medication-free obsessive-compulsive patients treated with cognitive-behavioural therapy
2013, Journal of Obsessive-Compulsive and Related DisordersCitation Excerpt :A high score e.g. in the PAS does not necessarily imply a co-morbid anxiety or panic disorder. Therefore, the focus of our study is different from the one in Storch et al. (2010). Our results indicate that CBT might be a useful therapy regardless of the patient's initial level of cognitive functioning.
Quality of life in obsessive-compulsive disorder: The role of mediating variables
2013, Psychiatry ResearchCitation Excerpt :When left untreated, OCD runs a chronic and debilitating course often contributing to interpersonal and psychological difficulties (Norberg et al., 2008). Comorbidity is common in those with OCD with approximately 70% of patients having a comorbid condition, most frequently depressive disorders or another anxiety disorder (Rasmussen, 1994; Storch et al., 2010). Obsessive-compulsive disorder has been associated with considerable functional impairment with the World Health Organization reporting that OCD accounts for 2.5% of global years lost due to disability (Ayuso-Mateos, 2000).
Does time-intensive ERP attenuate the negative impact of comorbid personality disorders on the outcome of treatment-resistant OCD?
2013, Journal of Behavior Therapy and Experimental Psychiatry