Groeps-, individuele en gecombineerde behandeling van de obsessieve-compulsieve stoornis
Summary
Objective: The primary aim of the study was to compare the effectiveness of group, individual and a combination of group and individual (combined therapy) cognitive behavioral therapy (CBT) in patients with obsessive compulsive disorder (OCD) in a naturalistic setting. A secondary aim was to identify predictive factors associated with treatment outcome in OCD patients.
Method: The Y-BOCS scores of 95 patients of the Altrecht Academic Anxiety Center, diagnoses with OCD, were compared. The patients aged 18-67 years and finished in 5-53 sessions individual, group or combined therapy. In addition, OCD severity, co-morbid psychiatric symptoms, co-morbidity with a mood disorder, hoarding and gender were examined at baseline as possible predictors of treatment outcome using multiple regression analysis.
Results: The Intention to treat (n = 95) and completer analyses (n = 75) indicated no differences between the group, individual and combined treatments on outcome measures (Y-BOCS and OCI-R). CBT was effective in reducing obsessive-compulsive symptoms in the completer sample (η2 = .059) but no effect was found in the intention to treat sample (η2 = .007). Second, worse treatment outcome was associated with OCD severity and the co-morbid anxiety symptoms at baseline. Somewhat surprisingly, co-morbid somatic complaints were associated with good prognosis.
Conclusion: The results of this study suggest that OCD can be treated effectively with a group format of CBT, thus sparing some therapist resources. The non-significant results of the intention to treat analyse shows that augmentation strategies are needed. Special attention should be paid to patients with severe OCD symptoms and a high level of anxiety.