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Objective: We explored the dynamic relationship between cognition and obsession severity during 2 different treatments for primary obsessions, examining evidence for the hypothesis that symptom reduction would be mediated by appraisals about the meaning of unwanted intrusive thoughts., Method: Data from a recent randomized controlled trial were analyzed with traditional mediation analyses and latent difference scores. The trial had compared cognitive behavioral therapy and stress management training among 73 patients with primary obsessions. Mediation analyses were conducted with pre-, post-, and follow-up scores on the Obsessions subscale of the Yale-Brown Obsessive Compulsive Scale and 2 self-report measures of cognitions related to obsessive-compulsive disorder. Bivariate dual change score (BDCS) analyses were conducted with weekly assessments of obsession severity and appraisals of personal significance., Results: Change in most cognitions related to obsessive-compulsive disorder accounted for reduction in obsession severity during the course of treatment and follow-up. BDCS analyses of the longitudinal data, however, indicated prior obsession severity is a leading indicator of subsequent change in appraisals, rather than the reverse. Analyses also suggested cognitive behavioral therapy is more effective than stress management training when symptoms are severe and that stress management training is more advantageous in the context of mild-to-moderate obsessions., Conclusions: The traditional mediation analysis indicated that appraisal change is a tenable mediator of obsession reduction, but the BDCS results raise doubts about the causal direction. The results highlight the importance of examining the dynamic relationship between putative mediators and outcome variables, and they suggest interesting hypotheses about mechanisms in treatment of obsessions.

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment., (2009 Elsevier Ltd. All rights reserved.)

Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward.

The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.

This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment.

Background: Individuals with major depression frequently have panic attacks, and often panic disorder, but rarely have researchers studied the impact of comorbidity of panic on the outcome of psychological treatment of depression., Methods: In this study, patients with comorbid panic and depression were first treated with cognitive-behavioral therapy (CBT) for panic. Depression symptoms in this treated group were compared to a group of patients with major depression who were on a minimal therapist contact waitlist. In the second phase of the study, patients in both groups (comorbid and depression-only) were treated with CBT for depression., Results: CBT for panic had little effect on co-existing depression, suggesting a specificity of action for CBT directed at different disorders. In addition, the presence of current or recently remitted panic attacks or agoraphobic avoidance did not interfere with the outcome of CBT for depression., Conclusion: These findings stand in contrast to previous studies showing greater linkage between depression and panic in treatment outcome., Limitations: While there are implications for treatment planning, these conclusions may be limited by the exclusion criteria and the highly structured treatment approach of separating treatment for panic from treatment for depression.

Panic disorder and major depression frequently coexist, yet the implications of comorbidity for psychological treatments have rarely been studied. The objective of this study was to evaluate whether pretreatment comorbidity of major depression affects the outcome of cognitive-behavioral treatment (CBT) of panic disorder. Thirty-seven clients who met diagnostic criteria for both panic and major depression participated in 10 sessions of individual CBT for panic. Treatment outcome was contrasted with the outcome of 53 clients having only panic disorder who received the same treatment. The co-occurrence of depression did not adversely affect CBT for panic. These results have implications for clinical practice and theoretical implications for the nature of the relationship between panic and depression.

This study represents a 2.25-year follow-up to a treatment study reported earlier (McLean & Hakstian, 1979) in which 121 unipolar depressed outpatients were treated by either (a) nondirective psychotherapy, (b) behavior therapy, (c) pharmacotherapy, or (d) relaxation therapy. A nondepressed, normal control group was evaluated on the same 28 measures and 6 intervals for contrast purposes. Behavior therapy patients alone were significantly improved in the areas of mood, personal productivity, and social activity, relative to treatment control patients over the follow-up period. Also, twice as many behavior therapy patients (i.e., 64%) fell within one standard deviation of the normal, nondepressed control group distribution on depressed mood, compared with non-directive psychotherapy and pharmacotherapy patients, when scores were aggregated across the 6 assessment points.

Ss with a strong fear of snakes were taught to increase and decrease their skin resistance during practice sessions with a continuous visual display. Ss were not aware that they were increasing or decreasing their levels of skin resistance and attempted only to influence the magnitude of the multimeter display, the polarity of which was controlled by the experimenter. The study used a within-subjects reversal design to investigate whether bidirectional control could be acquired over skin resistance level. To investigate whether this acquired control could affect the magnitude of elicited pre-conditioned autonomic responses, a pre- and post-training comparison was made between the GSRs elicited during test sessions in which Ss viewed slides of snakes while attempting to influence their electrodermal activity with the assistance of the visual display. The results suggest that Ss are able to acquire voluntarily bidirectional control of their level of skin resistance with continuous visual feedback and that this control can either depress or facilitate the magnitude of pre-conditioned emotional responses as a function of visual feedback.