Cognitive Changes in Patients with Obsessive Compulsive Rituals Treated with Exposure in vivo and Response Prevention

This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.

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Mechanisms of the Pharmacological Modulation of Obsessive-Compulsive and Cognitive Disorders in Cats Recognized by the Method of Normalizing FFT-Convertible Functions of Electrograms of the Frontal Cortex and Hippocampus

Biomeditsina ◽

10.33647/2074-5982-16-1-12-27 ◽

2020 ◽

Vol 16 (1) ◽

pp. 12-27 ◽

Cited By ~ 2

Author(s):

N. N. Karkischenko ◽

V. N. Karkischenko ◽

Yu. V. Fokin

Keyword(s):

Cognitive Functions ◽

High Frequency ◽

Cognitive Disorders ◽

Pharmacokinetic Parameters ◽

Frequency Range ◽

Obsessive Compulsive ◽

Cognitive Changes ◽

Pharmacological Modulation ◽

The Brain

The pharmacological modulation and analysis of psychopathological processes in animals is a research method providing a possibility to study similar processes in humans. Methods and approaches based on the principles of the pharmacological modulation of systemic behaviour and normalization of FFT-transformed functions of the brain electrograms allow identiﬁcation of the quantitative parameters of intracentral relations, cognitive functions and fundamental mechanisms for evaluating the effects of neuropsychoactive drugs in the whole brain in vivo.The work was carried out on cats with stereotactically implanted electrodes in the brain. Subtherapeutic doses of ketamine, amphetamine and nakom were used to model obsessive-compulsive disorders and cognitive changes. The pharmacological modulation of the animals’ behaviour was evaluated by the effect on the frontal brain and hippocampus. The activation of γ-rhythms (from 35 to 60 Hz) was considered as an improvement in cognitive functions. Ketamine exhibited a more pronounced depressing effect on the proreal gyrus, with its activating effects being close to amphetamine across the frequency ranges of 11–15 and 32–35 Hz. Ketamine had a pronounced activating effect on the gyrus suprasilvium anterior and the hippocampus. Ketamin and nakom demonstrated similar effects in the area of the proreal gyrus, most clearly manifested at frequencies of about 9–15 and 35–36 Hz. The action of nakom was characterized by the episodes of activation in a higher frequency range of 40–55 Hz as well. In the area of the gyrus suprasilvium anterior, the effects of nakom were similar to those of ketamine; however, these substances exhibited different effects in the range of 9–11 Hz. Compared to amphetamine, nakom showed no depressing episodes over the high-frequency range of 55–65 Hz. In the hippocampus, nakom demonstrated an activating effect exceeding that of ketamine by 100–150%. It was shown that neuroimaging of the normalized functions of electrograms during the pharmacological modulation of obsessive-compulsive and cognitive disorders reﬂects the most striking transformations in high-frequency brain rhythms, primarily related to the γ-range.Comparison of the results of pharmacomodulation with the pharmacodynamic and pharmacokinetic parameters of drugs when modelling psychopathologies in animals helps researchers in their search for approaches to modifying animal behaviour and extrapolating them to humans.

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Treating Sexual Orientation Obsessions

Sexual Obsessions in Obsessive-Compulsive Disorder ◽

10.1093/med-psych/9780190624798.003.0006 ◽

2019 ◽

pp. 163-206

Author(s):

Jenifer A. Viscusi ◽

Monnica T. Williams

Keyword(s):

Sexual Orientation ◽

Obsessive Compulsive Disorder ◽

Real Life ◽

Response Prevention ◽

Case Conceptualization ◽

Exposure And Response Prevention ◽

Obsessive Compulsive ◽

Compulsive Disorder

This chapter presents a case study of the treatment of sexual orientation obsessions in obsessive-compulsive disorder (also called SO-OCD or H-OCD for homosexual OCD). The case study includes information about the client background and case conceptualization of a male with upsetting sexual thoughts who was effectively treated using exposure and response prevention by the authors. Included are measures administered, Real-life examples of his exposure hierarchy, and sample imaginal exposures from the case that serve as realistic examples of what treatment may include. Additionally, this chapter includes additional detailed sample ideas of in vivo and imaginal exposures that can be used as part of treatment for SO-OCD for other clients.

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Treatment of an 11-year-old Obsessive-compulsive Ritualizer and Tiqueur Girl with in vivo Exposure and Response Prevention

Behavioural Psychotherapy ◽

10.1017/s0141347300008831 ◽

1983 ◽

Vol 11 (1) ◽

pp. 75-81 ◽

Cited By ~ 18

Author(s):

P. Zikis

Keyword(s):

Traumatic Event ◽

Specific Treatment ◽

Sudden Onset ◽

Home Treatment ◽

Response Prevention ◽

Exposure And Response Prevention ◽

Obsessive Compulsive ◽

Primary Problem

A case is described of an 11-year-old schoolgirl with both obsessive-compulsive rituals and tics of sudden onset following a traumatic event at the age of five. Treatment consisted of exposure in vivo and response prevention directed mainly towards her obsessive-compulsive rituals as they were considered the primary problem. Following the initial therapist–patient out-patient session and home treatment with her mother, the obsessive-compulsive rituals disappeared and the tics decreased. Three weeks later the tics disappeared without specific treatment and the patient has maintained her improvement at follow-up, 52 weeks later. The actual therapist–patient time was about an hour.

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Clomipramine and Exposure for Chronic Obsessive-Compulsive Rituals: III. Two Year Follow-Up and Further Findings

The British Journal of Psychiatry ◽

10.1192/bjp.140.1.11 ◽

1982 ◽

Vol 140 (1) ◽

pp. 11-18 ◽

Cited By ~ 61

Author(s):

D. Mawson ◽

I. M. Marks ◽

L. Ramm

Keyword(s):

Social Adjustment ◽

Age Of Onset ◽

Drug Effect ◽

Obsessive Compulsive ◽

Exposure In Vivo

SummaryForty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

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Clomipramine and Exposure for Compulsive Rituals: II. Plasma Levels, Side Effects and Outcome

The British Journal of Psychiatry ◽

10.1192/bjp.136.2.161 ◽

1980 ◽

Vol 136 (2) ◽

pp. 161-166 ◽

Cited By ~ 46

Author(s):

R. S. Stern ◽

I. M. Marks ◽

D. Mawson ◽

D. K. Luscombe

Keyword(s):

Side Effects ◽

Plasma Levels ◽

Plasma Concentrations ◽

Therapeutic Window ◽

Obsessive Compulsive ◽

Behavioural Treatment ◽

Primary Metabolite ◽

Exposure In Vivo

SummaryForty obsessive-compulsive ritualizers received nightly placebo or clomipramine up to 225 mgs nocte for 8 months, and received behavioural treatment (exposure in vivo) from weeks 4 to 10. Plasma concentrations of clomipramine and its primary metabolite N-desmethylclomipramine steadily increased over the first 4 weeks of treatment after which they remained relatively steady. Plasma levels correlated significantly with dose and with outcome but not with side effects. Patients with plasma clomipramine levels in the range 100–250 ng/ml and N-desmethylclomipramine levels between 230–550 ng/ml were found to improve significantly more than patients outside these ranges, thus suggesting a therapeutic window for clomipramine and its primary metabolite.

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Clomipramine and Exposure for Obsessive-Compulsive Rituals: 1

The British Journal of Psychiatry ◽

10.1192/bjp.136.1.1 ◽

1980 ◽

Vol 136 (1) ◽

pp. 1-25 ◽

Cited By ~ 268

Author(s):

I. M. Marks ◽

R. S. Stern ◽

D. Mawson ◽

J. Cobb ◽

R. McDonald

Keyword(s):

Social Adjustment ◽

Depressed Mood ◽

Obsessive Compulsive ◽

Double Blind ◽

Exposure In Vivo ◽

One Year ◽

Interactional Effect

SummaryForty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114.Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation.Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

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Treatment of Chronic Obsessive-Compulsive Neurosis by in-vivo Exposure

The British Journal of Psychiatry ◽

10.1192/bjp.127.4.349 ◽

1975 ◽

Vol 127 (4) ◽

pp. 349-364 ◽

Cited By ~ 196

Author(s):

I. M. Marks ◽

R. Hodgson ◽

S. J. Rachman

Keyword(s):

Group Treatment ◽

Antidepressant Treatment ◽

Real Life ◽

Response Prevention ◽

Special Treatment ◽

Individual Treatment ◽

Obsessive Compulsive ◽

Depressive Episodes

SummaryTwenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4–12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up.Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up.Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach.The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication.The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or antidepressant treatment. One quarter refused behavioural treatment after it was offered.Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

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