Upasana Baruah1, R Dhanasekara Pandian2, Janardhanan C Narayanaswamy3, Suresh Bada Math3, Thennarasu Kandavel4, Y C Janardhan Reddy3. 1. Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore 560029, Karnataka, India. Electronic address: upasana.baruah@gmail.com. 2. Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore 560029, Karnataka, India. 3. Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. 4. Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Abstract
BACKGROUND:Cognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD. METHOD: We randomized 64 adult OCD patients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) thatincluded psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3- months post-intervention. Primary outcome measure was response to treatment defined as ≥ 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression- Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed. RESULTS: At 3- month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p < 0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p < 0.001) and baseline illness severity (OR = 0.746, p < 0.011) predicted treatment response. LIMITATIONS: Sample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups. CONCLUSION: Briefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.
RCT Entities:
BACKGROUND: Cognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD. METHOD: We randomized 64 adult OCDpatients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) that included psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3- months post-intervention. Primary outcome measure was response to treatment defined as ≥ 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression- Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed. RESULTS: At 3- month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p < 0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p < 0.001) and baseline illness severity (OR = 0.746, p < 0.011) predicted treatment response. LIMITATIONS: Sample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups. CONCLUSION: Briefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.
Authors: Y C Janardhan Reddy; Paulomi M Sudhir; M Manjula; Shyam Sundar Arumugham; Janardhanan C Narayanaswamy Journal: Indian J Psychiatry Date: 2020-01-17 Impact factor: 1.759