Article2009

Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder

Andréa Litvin Raffin · Jandyra Maria Guimarães Fachel · Ygor Arzeno Ferrão · Fernanda Pasquoto de Souza · Aristides Volpato Cordioli

65 citations0/0 files storedEuropean Psychiatry

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Obsessive-Compulsive Spectrum Disorders Psychoanalysis and Psychopathology Research Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

PURPOSE: To identify the presence of factors associated with treatment outcome in patients under group cognitive-behavioral therapy (GCBT) for obsessive-compulsive disorder (OCD). SUBJECTS AND METHODS: This study evaluated 181 patients with OCD that attended a 12-session weekly GCBT program. Response criteria were: >/=35% reduction in Y-BOCS scores and global improvement score of the Clinical Global Impression (CGI)</=2 at post-treatment evaluation. Sociodemographic data, OCD characteristics, and treatment data were studied. RESULTS: In the bivariate analysis, the following variables showed statistical significance (p<0.20) to enter the regression model: being woman (p=0.074), greater insight (p=0.017) and better quality of life (QOL) in all domains before treatment (p=0.053), overall severity of disease according to the CGI (p=0.007), number of associated comorbidities (p=0.063), social phobia (p=0.044), and dysthymia (p=0.072). In the final regression model, these variables were associated with response to GCBT: female gender (p=0.021); WHOQOL-BREF psychological domain (p=0.011); insight (p=0.042); and global improvement score of the CGI severity-scale before therapy (p=0.045). CONCLUSION: Special attention should be paid to patients with poor insight, increasing the cognitive aspects of the therapy in an attempt to modify the rigidity and fixity of their beliefs. In addition, male patients should be more observed, since they showed lower chance of response to GCBT when compared to women. Patients with more severe global symptoms (CGI) are poorer responders to GCBT, which indicates that not only obsessive-compulsive symptoms (OCS) should be evaluated, since other symptoms, such as depression and anxiety, may affect the treatment; therefore, an attempt to reduce these symptoms, prior to the treatment of OCD, should be considered as an option in some cases.

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References

2005Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication 1976ECDEU Assessment Manual for Psychopharmacology 1989The Yale-Brown Obsessive Compulsive Scale 1989The Yale-Brown Obsessive Compulsive Scale 1994The Yale-Brown Obsessive-Compulsive Scale: Measures of internal consistency 2000Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida "WHOQOL-bref"2000Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais 2004Randomized, Placebo-Controlled Trial of Exposure and Ritual Prevention, Clomipramine, and Their Combination in the Treatment of Obsessive-Compulsive Disorder

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