2. Aims of the workshop
Identify the recommended treatments for OCD
(NICE guidelines)
Identify how and where group treatment for OCD
is incorporated into the NICE guideline
Examine the evidence base for group CBT for
OCD
Examine the advantages and disadvantages for
group CBT for OCD
Examine how group therapy for OCD works in
practice
3. The prevalence of OCD is estimated at:
A
1-3%
B
4-7%
C
8-11%
D
12-15%
4. NICE Guidelines do not recommend
which treatment for OCD?
A
B
CBT (with exposure and SSRI’s
response prevention)
C
D
Psychodynamic
psychotherapy
Group CBT
5. Which of the following modes of delivery have been
tested with OCD:
1) Bibliotherapy
2) cCBT
3) Group CBT
4) Telephone
A
1,2,3 & 4
B
1,3 & 4
C
1& 4
D
2,3 & 4
6. Which of the following low intensity interventions do NICE
recommend:
1) cCBT
2) Brief individual CBT
3) Group CBT
4) CBT delivered by telephone
A
1, 2, 3 & 4
B
1&2
C
2, 3 & 4
D
2&4
7. Nice guidelines determine low intensity
treatments as less than how many
therapist hours?
A
B
5
10
C
D
15
20
8. The most common outcome measure used in
treatment studies is the ?
A
B
BDI
OCC
C
CORE-OM
D
YBOC’s
9. In 1996 OCD was ranked as the ?th leading
cause of disability
A
8th
B
9th
C
10th
D
11th
10. Obsessive compulsive disorder
OCD is a major disorder is and under
recognized public health problem.
10th leading cause of disability by
WHO
Lifetime prevalence (1.9-3.0%)
There is evidence that without
adequate treatment the disorder
tends to have a chronic fluctuating
course
11. Obsessions
Obsessions are repetitive, recurring thoughts,
ideas, images or impulses that are experienced
as intrusive and are usually distressing or
anxiety provoking. Such thoughts are often
centered on dirt and contamination, accidental
harm, illness, aggression, sex, orderliness and
perfection.
12. Compulsions
Compulsions (rituals) are repetitive and
intentional acts and serve to reduce anxiety the
thoughts provoke. The person recognizes that
their behavior is excessive or unreasonable.
13. NICE Guidelines
Obsessive compulsive disorder:
core
interventions in the treatment of obsessive compulsive
disorder and body dysmorphic disorder
Published 2005
14. What is NICE?
National Institute for Health and Clinical
Excellence
Part of the NHS
Established 1999
Produces Clinical Guidelines for the
“appropriate treatment and care of people
with specific diseases and conditions
within the NHS in England and Wales”
15. What does the NICE OCD/BDD
guideline cover
Children, young people and adults with OCD/BDD –
mild, moderate and severe functional impairment
A stepped-care approach to recognition, assessment,
treatment interventions, intensive treatment and inpatient
services, discharge and re-referral
Who is it aimed at?
Healthcare professionals who share in the treatment and
care of people with OCD/BDD
Commissioners of services
Service users, families/carers
16. NICE recommendations
identified as key priorities
All people with OCD should have
access to evidence-based treatments:
CBT including exposure and
response prevention (ERP) and/or
pharmacology
CBT (including ERP) should be
offered in a variety of formats
17. Treatment options for adults with OCD
Mild functional
impairment
Brief CBT (+ERP)
< 10 therapist hours
(individual
or group
formats)
Moderate functional
impairment
Offer choice of:
more intensive CBT
(+ERP)
>10 therapist hours
or
course of an SSRI
Patient cannot engage in/CBT
(+ERP) is inadequate
Severe functional
impairment
Inadequate
response at 12
weeks
Multidisciplinary
review
Offer combined
treatment of
CBT (+ERP)
and an SSRI
19. Low intensity interventions
Brief individual CBT (including ERP)
using structured self help
Brief individual CBT (including ERP) by
telephone
Group CBT (including ERP)
20. Exposure and response
prevention
Exposure is the therapeutic confrontation to a
feared stimulus in imagination or in vivo until
fear subsides (process known as habituation).
Response prevention is resisting carrying out
the ritual.
21. Small group work
In small groups discuss for 10 minutes the
advantages and disadvantages of group
treatment for people with OCD
Identify a scribe to feedback to the large
group
22. Advantages of group treatment
Cost effective
‘sharing’ of experiences between
participants
Possibly more motivating for participants
23. Disadvantages of group
treatment
Some people don’t like group treatment
Difficult to organise at a convenient time
for all group members
It may be more difficult to involve
families/relatives
24. Group CBT – The evidence base
Cordioli et al (2003) RCT: compared efficacy of group CBT with
waiting list control
McLean et al (2001) RCT: compared efficacy of two group
treatment types (CBT or ERP) by two time frames (immediate or
delayed start)
Jones & Menzies (1998) RCT compared efficacy of DIRT with a
waiting list control
Fals-Stewart et al (1993) RCT compared effectiveness of group
behaviour therapy with individual behaviour therapy
Emmelkamp et al (1988) RCT compared group cognitive therapy
(RET) with group behaviour therapy (exposure in vivo)
25. Systematic review
Reviewed 13 trials of group CBT treatment. Overall
pre–post-ES of these trials of 1.18 and a between-group
ES of 1.12 compared with waiting list control in three
randomized controlled studies indicate that group
CBT/ERP is an effective treatment for OCD. Group CBT
achieved better results than pharmacological treatment
in two studies. One study found no significant differences
between individual and group CBT.
Jónsson & Hougaard Group cognitive behavioural therapy for obsessive–
compulsive disorder: a systematic review and meta-analysis (2009). Acta
Psychiatrica Scandinavica, Volume 119, Pages: 98-106
26. What does this evidence mean
Post treatment, group CBT was found to be
more effective than either no therapy or
sertraline, but no different than ERP
There are no RCTs in adults with OCD
comparing the effectiveness of group CBT with
individual CBT.
Group CBT for OCD is effective
Further research is needed to evaluate individual
versus group CBT for OCD.
27. Group CBT - Application
Pre attendance
Detailed individual assessment of problem
Explanation of group process,
expectations and treatment model to
enable the individual to make an informed
decision
Willingness and commitment to participate
in group CBT
28. Group CBT - Application
Closed group format
5 – 12 participants
1 or 2 therapists
Weekly or twice weekly sessions
1 – 2.5 hours duration
7 -12 sessions plus follow up
Pre, post and follow-up measures
29. Group CBT - Application
Education regarding OCD and
treatment model
CBT including ERP
Relapse prevention
Between session tasks tasks
Monitoring progress
Telephone contact between sessions if
required
31. Evaluation
Was the workshop at the right level
Did it cover what you wanted
What did you like
What would you want to change if we were to do
the workshop again
32. Thank you for listening
Karina.Lovell@manchester.ac.uk
Notes de l'éditeur
1960’s
3-13%
1,2,3 &4
1,2,3 &4
1995
Problem solving
Problem solving
NOTES FOR PRESENTER
Please refer to the NICE guideline and QRG (pages 10 and 11) for the full overview of treatment pathway
Mild functional impairment: if the patient cannot engage in CBT (with ERP) or CBT (with ERP) is inadequate, consider:
Moderate functional impairment:if inadequate response at 12 weeks, multidisciplinary review and consider:
Severe functional impairment:if inadequate response at 12 weeks, or no response to SSRI or patient has not engaged in CBT, consider: (refer to MDT expertise in OCD for assessment and further planning next slide 15)
Refer to QRG (page 10) and NICE guideline –
Section 1.5.1 to 1.5.1.7
The intensity of psychological treatment has been defined as the hours of therapist input per patient. By this definition, most group treatments are defined as low intensity treatment (less than 10 hours of therapist input per patient), although each patient may receive a much greater number of hours of therapy.
CBT and ERP can be delivered in a variety of ways e.g. individual / group therapy, telephone, books and self-help.
Krone et al (1991) 36 patients in group programme
DIRT 1 therapist