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Background This study extends previous research by exploring whether changes in obsessive beliefs and metacognitions that were associated with changes in obsessive–compulsive disorder (OCD) symptom severity over the course of group behavioral treatment were maintained at long-term follow-up. Methods Forty patients with a primary diagnosis of OCD participated. The between- and within-person effects were investigated with multilevel longitudinal models. Predictor variables were obsessive beliefs and metacognitions. Results Across the study period, with a mean 8-year follow-up, obsessive and metacognitive beliefs significantly declined. There were significant between-person effects for metacognition and obsessive beliefs on OCD symptom severity. When the overlap between the obsessive belief factors was controlled for, only changes in metacognitions emerged as an independent predictor of OCD symptom severity. A further analysis revealed that metacognitive beliefs regarding the need to control thoughts made a separate contribution at both the between- and within-person levels. Conclusions The results indicate that decreases in metacognitive beliefs during OCD treatment can also have important long-term consequences.

The potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p d = 0.27, p p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment for OCD that is delivered in routine clinical care. The aim of this study was to examine the long-term effectiveness of behavioral treatment for OCD in a Norwegian general outpatient clinic. In the current study, 62% ( N = 40) of the original patients treated in a previously published study of group ERP for OCD were re-evaluated an average of eight years after completing the original treatment. This is the longest follow-up study that has been conducted for OCD patients treated with group ERP. There was a significant reduction in symptoms from pre- to post-treatment measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Spielberger State Anxiety Inventory (STAI-S) and the Beck Depression Inventory (BDI). The gains were in average maintained from post-treatment through extended long-term follow-up. Fifty percent of the participants experienced either a clinically significant improvement (10%) or recovery (40%) in OCD symptoms at extended long-term follow-up. This suggests that many patients receiving general outpatient mental health clinic based group ERP for OCD maintain gains over the long-term.

Background This study sought to investigate the effectiveness of group treatment for trichotillomania (TTM) in ordinary clinical settings. Treatment consisted of a combination of habit reversal training (HRT) and acceptance and commitment treatment (ACT). Both short- and long-term effects were explored, as well as individual change trajectories. Methods The sample consist of fifty-three patients with TTM. Treatment outcomes were evaluated at post-treatment and at one-year follow-up using self-report questionnaires (Massachusetts General Hospital Hair Pulling Scale, MGH-HS), structured clinical interviews (National Institute of Mental Health Trichotillomania Severity Scale, NIMH-TSS), and the Clinical Global Impression scale for TTM (CGI-TTM). Results Analyses by mixed models for repeated measurements yielded a statistically significant effect of time (p Conclusions ACT-enhanced behavior therapy in a group format seems efficient for reducing symptoms of trichotillomania.

Objective We examined the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12−16 years of age) with anxiety, and tested whether brief CBT was noninferior to standard duration CBT. Method A randomized controlled study of 313 adolescents (mean 14.0 years, SD = 0.84, 84% girls) were recruited through school health services to 10 weeks CBT group interventions. Groups of 5 to 8 adolescents were randomly allocated to brief (5 sessions, comprising 5.5 hours) or standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Self-reported and parent-reported youth anxiety symptoms, impairment from anxiety, depressive symptoms,and clinical severity were assessed pre- and postintervention, after WL, and at 1-year follow-up. Results Targeted school based CBT significantly reduced adolescents’ anxiety symptoms with small to moderate effect sizes compared to WL (Cohen d = 0.34 for youth report and d = 0.53 for parent report). According to the parents, also adolescents’ impairment from anxiety was significantly reduced compared to WL (d = 0.51). Pre to post changes in anxiety symptoms were small to moderate (within-group effect sizes between d = 0.41 and d = 0.67). Although no significant differences in effects were found between brief and standard CBT, brief CBT was not noninferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up. Conclusion Targeted school-based CBT interventions reduced anxiety, impairment, and depressive symptoms in adolescents. Both brief and standard CBT demonstrated efficacy, but brief CBT was not noninferior to standard CBT. By administering school-based CBT to youths with anxiety symptoms, we may reach young people with effective interventions at an earlier phase in their lives. Clinical trial registration information School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/ ; NCT02279251 .

Background, aims and objectives: When research investigates how patients obsessive compulsive disorder (OCD) are doing after therapy they usually report a symptom level at single points in time. The goal of the present study was to reveal a more multidimensional description of what OCD patients who have received treatment might find valuable when dealing with OCD symptoms in the long term. Methods: Fifteen patients with OCD who had received group exposure and prevention response therapy (ERP) between 6 and 11 years ago were recruited to attend focus groups. Eleven of the patients had received various other treatments in addition. The present symptom-level varied from none to severe OCD symptoms. The patients were asked open-ended questions concerning what they had learned from the group ERP, which they all had as denominator and how they dealt with the OCD symptom variations over time. The interviews were audiotaped, transcribed and analysed phenomenologically. Results: The overall finding was that the patients had achieved a foundation for a relaxed solution-oriented attitude regarding their OCD, regardless of their Yale-Brown Obsessive Compulsive Scale (Y-BOCS) level. The foundation for the attitude consisted of a new self-understanding, a higher evaluation of themselves, externalization and devaluation of OCD, where the OCD was seen in terms of symptoms and not as behaviour crucial to their identity, seeing OCD as possible to influence and maintaining several self-management strategies. Concretely, patients used parts of ERP such as: reminding themselves that bad emotions will eventually subside, comparing their behaviour to normal standards, recalling specific exposure exercises they undertook in therapy and using less formal exposures than in therapy. Furthermore, the patients made efforts to reduce their general stress level and took breaks from routines. One patient even avoided everyday habits to prevent the occurrence of new rituals. Surprisingly, none of the participants used formal ERP as they were taught. Conclusion: The present study provides valuable experience-based knowledge which might serve as input to future the development of a multidimensional assessment tool which can evaluate whether OCD patients have attitudes and strategies that make them able to cope with symptom variations. The results also indicate ways in which future improvements in OCD treatment can be achieved. Finally, the study points to the need to develop strategies to increase engagement in formal ERP after therapy. We advance our study as an important contribution to the literature on person-centered OCD management.