A controlled single case study with repeated fMRI measurements during the treatment of a patient with obsessive-compulsive disorder: Testing the nonlinear dynamics approach to psychotherapy

ObjectiveA growing body of research evidence shows that individuals with Obsessive Compulsive Disorder (OCD) have been negatively affected by the COVID-19 pandemic including deterioration of OCD symptoms plus relapse from previously well-controlled OCD. The impact of the COVID-19 pandemic is discussed in a single case study of a patient with OCD consisting of contamination concerns. In addition, the effectiveness of providing Exposure and Response Prevention (ERP) virtually is evaluated with regards to the treatment outcome in COVID-19 related OCD.Case reportThis study describes a 41-year-old, single, employed female with OCD consisting of concerns of contamination and infecting others thereby causing harm. The total duration of the disorder is 32 years with the most recent presentation being of three years duration. Relapse during the pandemic resulted in OCD symptoms being solely concerned with COVID-related contamination. The questionnaires routinely completed at the time of assessment and treatment were the Obsessive Compulsive Inventory (OCI); Yale Brown Obsessive Compulsive Scale (YBOCS); Beck Depression Inventory (BDI). Clinical data were collated and analysed prior to and during the pandemic. Treatment consisted of ERP and was adapted for provision via a virtual platform. ERP involved exposure to a graded hierarchy of COVID-specific anxiety-provoking situations modified to take government guidelines into consideration.DiscussionPrior to the COVID-19 pandemic the patient's response to treatment with cognitive behavioural therapy (CBT) including ERP indicated a 79% improvement in OCD symptoms on self -rated measures. The impact of the pandemic led to a significant 65% deterioration in OCD symptoms, regarding COVID-19 contamination concerns. Intervention with ERP resulted in 73% improvement over a three-month period. Measures of depression symptoms indicated an 80% improvement pre-COVID, with a 78% deterioration at relapse. Following treatment, the patient also showed a 65% improvement in depression symptoms. Improvements have been maintained at one month follow-up.ConclusionThe case study supports literature indicating the exacerbation of OCD symptoms due to the COVID-19 pandemic for patients with contamination fears and washing compulsions. The promising results support the use of ERP as an effective treatment for COVID-related OCD symptoms. It also validates the provision of CBT interventions virtually to ensure accessibility of treatment to OCD sufferers.

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Acceptance and Commitment Therapy-Specific Processes in the Psychotherapeutic Treatment of Obsessive Compulsive Disorder: A Single Case Study

Clinical Case Studies ◽

10.1177/1534650117694269 ◽

2017 ◽

Vol 16 (4) ◽

pp. 313-327

Author(s):

Claire Heather Boynton Wheeler

Keyword(s):

Acceptance And Commitment Therapy ◽

Rating Scale ◽

Single Case ◽

Well Being ◽

Single Case Study ◽

Obsessive Compulsive ◽

Clinical Change ◽

Compulsive Disorder ◽

Acceptance And Commitment

This single case study describes acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) used with a client presenting with symptoms of obsessive compulsive disorder (OCD). Standardized and idiographic outcome measures, including OCD-specific measures (Brief Yale-Brown Obsessive Compulsive Scale; Obsessional Compulsive Inventory), general measures of well-being and risk (CORE Outcome Measure; Outcome Rating Scale), an idiographic measure (Easy Personal Questionnaire), and a Sessional Rating Scale, were used across baseline and treatment phases. Statistical measures of reliable and clinical change were calculated, and client perspective on change was sought through interview. Cause–effect analysis was used to evaluate the extent to which therapeutic change was due to ACT-specific processes. Results showed reliable positive change with a probability of p < .05 across measures, and clinical change in three of five of the measures in which it could be calculated. The client reported improvements in well-being and the extent to which she lives her life according to her values. ACT-specific processes as well as generic therapy processes influenced change. The client’s own strengths and personal contributions to therapy played a major role in her achievement of therapeutic goals. The use of ACT with ERP in treating OCD and collaborative use of outcome measures with careful evaluation are recommended to clinicians.

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When the Problem is Beneath the Surface in OCD: The Cognitive Treatment of a Case of Pure Mental Contamination

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465812000252 ◽

2012 ◽

Vol 40 (4) ◽

pp. 383-399 ◽

Cited By ~ 11

Author(s):

Emma Warnock-Parkes ◽

Paul M. Salkovskis ◽

Jack Rachman

Keyword(s):

Cognitive Therapy ◽

Single Case ◽

Single Case Study ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Mental Contamination ◽

Cognitive Behavioural ◽

History Of

Background: Mental contamination is a phenomenon whereby people experience feelings of contamination from a non-physical contaminant. Rachman (2006) proposes that standard cognitive behavioural treatments (CBT) need to be adapted here and there is a developing empirical grounding supporting the concept, although suggestions on adapting treatment have yet to be tested. Method: A single case study is presented of a man with a 20-year history of severe treatment resistant Obsessive Compulsive Disorder (OCD) characterized by mental contamination following the experience of “betrayal”. He was offered two consecutive treatments: standard CBT and then (following disengagement with this) a cognitive therapy variant adapted for mental contamination. Clinician and patient rated OCD severity was measured at baseline and the start and end of both interventions. Results: Six sessions of high quality CBT were initially attended before refusal to engage with further sessions. There were no changes in OCD severity ratings across these sessions. A second course of cognitive therapy adapted for mental contamination was then offered and all 14 sessions and follow-ups were attended. OCD severity fell from the severe to non-clinical range across these sessions. Conclusions: The need to consider adapting standard treatments for mental contamination is suggested. Limitations and implications are discussed.

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CONSTRUCTIVIST STRATEGIES IN COGNITIVE-BEHAVIORAL THERAPY FOR MANAGING OBSESSIVE-COMPULSIVE DISORDER: A CASE STUDY

10.26226/morressier.5d1a037457558b317a14043d ◽

2019 ◽

Author(s):

Cristina Varanda ◽

Isabelle Salas

Keyword(s):

Cognitive Behavioral Therapy ◽

Obsessive Compulsive Disorder ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Acceptance and Commitment Therapy in Obsessive–Compulsive Disorder: A Case Study

Indian Journal of Psychological Medicine ◽

10.1177/0253717621996734 ◽

2021 ◽

pp. 025371762199673

Author(s):

Joel Philip ◽

Vinu Cherian

Keyword(s):

Obsessive Compulsive Disorder ◽

Acceptance And Commitment Therapy ◽

Behavioral Therapy ◽

Third Wave ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Change Acceptance ◽

Commitment Therapy ◽

Acceptance And Commitment

Recent years have witnessed an increased interest in the use of “third-wave” psychotherapies in treating psychiatric disorders. These newer therapies are fundamentally different from the existing techniques such as cognitive behavioral therapy in terms of their guiding principles and processes of change. Acceptance and commitment therapy (ACT) is the most prominent among these “third wave” psychotherapies. However, there have not been any reports from India, thus far, that have studied the use of ACT in treating obsessive–compulsive disorder (OCD). We describe a case of OCD that was successfully treated with eight sessions of ACT, with the results being maintained over a one-month follow-up period. Postintervention tests revealed a significant decrease in obsessive–compulsive symptoms and an associated increase in psychological flexibility. This case study highlights the possible utility of ACT as a therapeutic intervention in OCD, especially when combined with pharmacotherapy.

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