OCD Action Group Therapy presentation by Karina Lovell

1. Group CBT for OCD
Professor Karina Lovell

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

18. Interventions for OCD


Cognitive Behaviour Therapy (exposure and
response prevention)
Pharmacological (SSRI’s)

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

30. Any questions

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