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Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD Using Cognitive Bias Modification

Abstract

Exposure and Response Prevention (ERP) is the most effective treatment for OCD but it is not accessible to most patients. Attempts to increase the accessibility of ERP via self-directed ERP (sERP) programs such as computerized delivery and bibliotherapy have met with noncompliance, presumably because patients find the exposure exercises unacceptable. Previous research suggests that Cognitive Bias Modification (CBM) interventions may help individuals approach feared situations. The goal of the current study was to test the efficacy of a treatment program for OCD that integrates sERP with CBM. Twenty-two individuals meeting diagnostic criteria for OCD enrolled in our 7-week treatment program. Results suggest that sERP with CBM led to significant reduction of OCD symptoms and functional impairment. Indeed, the magnitude of the effect of this novel treatment, that requires only an initial session with a clinician trained in ERP for OCD, was comparable to that of the gold standard clinician-administered ERP. Moreover, preliminary evidence suggests that CBM interventions targeting interpretation bias may be most effective, whereas those targeting attention and working memory bias may not be so.

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Fig. 1

Notes

  1. 1.

    We calculated Reliable clinical change (RCI) as follows (Jacobson and Truax 1991): \(RCI = \frac{{x_{1} - x_{2} }}{{S_{diff} }},\;S_{diff} = \sqrt {2(S_{E} )^{2} } ,\;S_{E} = s_{1} \sqrt {1 - r_{xx} } ,\) x1 = pre-assessment Y-BOCS mean, x2 = post-assessment Y-BOCS mean, s1 = standard deviation of current sample at pre-treatment, rxx = test–retest reliability of the Y-BOCS. Test–retest reliability of .79 was obtained from Steketee et al. (1996b).

  2. 2.

    Change scores for the time corresponding to the psychoeducational video week were unavailable for four participants who failed to complete the OCI-R at the end of that week.

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Acknowledgments

This research was supported by National Institute of Health grant R01MH087623 awarded to the first author, Nader Amir. Nader Amir has a financial interest in Cognitive Retraining Technologies Incorporated, a company that markets anxiety relief products.

Conflict of Interests

Jennie Kuckertz, Sadia Najmi, and Sara Conley declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the APA and the Institutional Review Board. Informed consent was obtained at the beginning of the study from all individual subjects participating in the study.

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Amir, N., Kuckertz, J.M., Najmi, S. et al. Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD Using Cognitive Bias Modification. Cogn Ther Res 39, 424–440 (2015). https://doi.org/10.1007/s10608-015-9675-7

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Keywords

  • Obsessive–compulsive disorder
  • Cognitive bias modification
  • Exposure
  • Attentional bias
  • Interpretation bias