Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up
Braga DT, Cordioli AV, Niederauer K and Manfro GG;
Commented by , 27 Sep 2005
Background
Cognitive-behavioral therapy (CBT) and cognitive-behavioral group therapy (CBGT) have been shown to be effective treatments for obsessive-compulsive disorder (OCD). Little is known, however, about whether the positive results gained from this type of treatment are maintained over time.
Aims of the study
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To investigate the rate of relapse in patients with OCD during the 12 months following remission or significant improvement after CBGT
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To investigate pre-treatment predictors of long-term outcome
Method
42 patients with OCD received 12 sessions of CBGT. Remission (Y-BOCS < 8) or significant improvements (reduction of > or = 35% on the Y-BOCS) were obtained in 31 patients.
Patients whose OCD had remitted or was significantly improved were re-evaluated 3, 6 and 12 months after treatment. Relapse was defined as an increase of > or = 35% on the Y-BOCS at follow-up.
Results
12 months after the end of the treatment, remission or improvement were maintained in 20 patients. A relapse was observed in 11 patients (3 during the first 3 months, 4 during the next three months, 4 after the last six months).
The extent of symptom reduction at the end of CBGT was a strong predictor of non relapse. Age at onset, comorbid disorders, and severity of symptoms at baseline were not associated with relapse.
Professor Pull's comments
OCD is a chronic, lifelong disorder.
As shown by a number of acute treatment studies, remissions or significant improvements may be achieved with anti-obsessional medication (e.g., clomipramine or selective serotonine reuptake inhibitors) and with cognitive-behavioral therapy (e.g., exposure and response prevention or cognitive restructuring), either as stand alone treatments or as combination treatments associating medication and psychotherapy.
Longitudinal treatment studies with prolonged follow-up periods in OCD are still rare however and there is a conspicuous lack of long-term randomized controlled follow-up studies comparing the efficacy of medication, CBT or a combination of both.
As a consequence, little is known about the relapse rate in the months and years following treatment with medication alone, with CBT alone or with a combination of medication and CBT.
Patients tend to relapse in the months following discontinuation of treatment with medication alone, while relapses after treatment with medication and CBT have been shown to be less frequent or to occur later. There are, however, only limited data on the long term efficacy of CBT.
Even less is known about the long term efficacy of CBGT. As such the study by Braga et al is a welcome addition to the data base in this field. The results of the study support the efficacy of CBGT in the short and long term treatment of OCD.
In particular, patients with full symptom remission after CBGT tended to maintain their gains over time. These are important finding since CBGT is much less expensive and time-consuming than individual CBT.
The main limitation of the study, apart from its small sample size, lies in the fact that it is a simple follow-up study, not a randomized controlled study.