Treatment of obsessions: A randomized controlled trial

doi:10.1016/j.brat.2009.11.010

Behaviour Research and Therapy

Volume 48, Issue 4, April 2010, Pages 295-303

https://doi.org/10.1016/j.brat.2009.11.010 Get rights and content

Abstract

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre–post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.

Section snippets

Design

Participants were randomized to type of treatment (CBT or SMT) and to a start time (immediate or 3-month delay). Treatment consisted of 12 h-long individual sessions plus an information gathering session following the diagnostic interview. Assessments were completed at intake, following 12 weeks of waitlist for those randomized to receive delayed treatment, and post-treatment, as well as six and 12 months follow-up.

Based on previous research (Freeston et al., 1997, Lindsay et al., 1997), the

Data analytic strategy

Analysis of covariance (ANCOVA) was first used to compare outcome variables following the waitlist with participants who received immediate treatment with CBT or SMT, controlling for initial status. To compare CBT and SMT with more power, we next repeated ANCOVA analyses comparing all patients who received CBT or SMT, regardless of whether treatment was immediate or delayed. Several multivariate outliers were detected in initial examination of the data. In most cases, results did not differ

Discussion

According to the cognitive theory, obsessions are caused by serious misinterpretations of the personal significance of intrusions. It follows that if these maladaptive interpretations are reduced or eliminated by formal therapy, or by any other means, then the frequency and the distress of the obsessions will steeply decline. CBT and SMT for primary obsessions resulted in a strong and broad treatment effect when compared to waitlist. Large effect sizes emerged for both treatments on the YBOCS

Author note

The authors would like to thank Melanie O'Neill and David Jacobi, who served as postdoctoral fellows on the study. Additionally, we appreciate the contributions of Sarah Newth and Nichole Fairbrother. David A. Clark and Arnoud Arntz kindly read an earlier version of the manuscript and provided helpful feedback. This research was funded by the Canadian Institutes of Health Research.

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Treatment of obsessions: A randomized controlled trial

Abstract

Section snippets

Design

Data analytic strategy

Discussion

Author note

Journal of Behavior Therapy and Experimental Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Clinical Psychology Review

Cognitive and Behavioral Practice

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behavior Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Empirical status of cognitive–behavioral therapy for obsessive–compulsive disorder: a meta-analytic review

Romanian Journal of Cognitive and Behavioral Psychotherapies

Diagnostic and statistical manual of mental disorders (DSM-IV)

An inventory for measuring clinical anxiety: psychometric properties

Journal of Consulting and Clinical Psychology

Manual for the beck anxiety inventory

Beck depression inventory manual

Two psychological treatments for hypochondriasis: a randomized controlled trial

British Journal of Psychiatry