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Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted. Key learning aims (1) Feasibility of internet-assisted cognitive behavioural therapy (I-CBT) for non-cardiac chest pain (NCCP). (2) How NCCP patients experience I-CBT. (3) Possible effects of I-CBT. (4) How I-CBT can be delivered at the Cardiac Department.

A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients with autogenous thoughts who appraised their intrusions as more important than others. OCD is heterogeneous regarding thought content and strength of appraisals but can be quite homogeneous in terms of CBT treatment response. Also, and in line with cognitive theory, recovery from OCD is associated with changes in appraisals.Keywords: obsessive-compulsive disorder (OCD); cognitive behavioral therapy (CBT); intrusive thoughts; appraisal; cognition; metacognitionSeveral theories attempting to explain the pathogenesis and treatment of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive factors (Clark & Purdon, 1993; Rachman, 1997; Salkovskis, 1985). These theories have often been termed appraisal theories given the significance of subjective interpretation of intrusions. Appraisal theories postulate that intrusions can be placed on a dimension of normal cognitive phenomenon and that appraisal is partly derived from more enduring underlying beliefs and determine whether or not intrusions develop into clinical obsessions.Given the increasing number of cognitive theories hypothesizing the significance of beliefs and appraisals of intrusive thoughts in OCD as well as a lack of validated and reliable measures of these cognitive constructs, the Obsessive-Compulsive Cognitions Working Group (OCCWG; 1997, 2001, 2003, 2005) developed the Obsessive Beliefs Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III). In contrast to the OBQ, which was designed to assess general beliefs relevant to OCD, the III is a semi-idiographic self-report questionnaire designed to measure immediate appraisals or interpretations of intrusions (OCCWG, 1997, 2001). The III provides examples of intrusive thoughts and asks participants to list their two main intrusive thoughts. Appraisal of these two thoughts are measured using 31 items which were originally believed to reflect three theoretically derived domains important in understanding the etiology and persistence of OCD: (a) inflated responsibility, (b) overimportance of thoughts, and (c) excessive concern about the importance of controlling one's thoughts.Inflated responsibility refers to beliefs and appraisals of intrusions that one has power to both create and avert negative outcomes (OCCWG, 1997) and is largely based on the inflated responsibility theory developed by Salkovskis (1985). The theory proposes that normal unwanted intrusive thoughts will develop into clinical obsessions only if the trigger thoughts are appraised or interpreted as indicating personal responsibility. Overimportance of thoughts refers to the beliefs and appraisals concerning that "the mere presence of a thought indicates that it is important" (OCCWG, 1997, p. 678) and is largely based on the misinterpretation of significance theory developed by Rachman (1997). Control of thoughts refers to the tendency to overestimate the significance of controlling one's thoughts and that this is attainable and desirable (OCCWG, 1997) and is largely based on the cognitive control theory developed by Clark and Purdon (Clark & Purdon, 1993; Purdon & Clark, 1994). …

Key Points Question Does D-cycloserine potentiate the effect of concentrated exposure and response prevention in difficult-to-treat obsessive-compulsive disorder? Findings In this randomized clinical trial of 163 participants, D-cycloserine did not significantly affect treatment outcomes. Most patients responded to the concentrated exposure and response prevention treatment, and nearly 50% were recovered at 1-year follow-up. Meaning In this study, concentrated exposure and response prevention treatment was effective for patients with difficult-to-treat obsessive-compulsive disorder, but adding D-cycloserine did not potentiate the treatment., This randomized clinical trial evaluates whether D-cycloserine potentiates the effect of concentrated exposure and response prevention among patients with difficult-to-treat obsessive-compulsive disorder., Importance Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. Objective To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD. Design, Setting, and Participants The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Participants were adult outpatients with difficult-to-treat OCD. A total of 220 potential participants were referred, of whom 36 did not meet inclusion criteria and 21 declined to participate. Patients had either relapsed after (n = 100) or not responded to (n = 63) previous ERP treatment. A total of 9 specialized OCD teams within the public health care system in Norway participated, giving national coverage. An expert team of therapists from the coordinating site delivered treatment. Inclusion of patients started in January 2016 and ended in August 2017. Data analysis was conducted February to September 2019. Interventions All patients received individual, concentrated ERP treatment delivered during 4 consecutive days in a group setting (the Bergen 4-day treatment format) combined with 100 mg DCS, 250 mg DCS, or placebo. Main outcomes and Measures Change in symptoms of OCD and change in diagnostic status. Secondary outcomes measures included self-reported symptoms of OCD, anxiety, depression, and quality of life. Results The total sample of 163 patients had a mean (SD) age of 34.5 (10.9) years, and most were women (117 [71.8%]). They had experienced OCD for a mean (SD) of 16.2 (10.2) years. A total of 65 patients (39.9%) were randomized to receive 100 mg DCS, 67 (41.1%) to 250 mg of DCS, and 31 (19.0%) to placebo. Overall, 91 (56.5%) achieved remission at posttreatment, while 70 (47.9%) did so at the 12-month follow-up. There was no significant difference in remission rates among groups. There was a significant reduction in symptoms at 12 months, and within-group effect sizes ranged from 3.01 (95% CI, 2.38-3.63) for the group receiving 250 mg DCS to 3.49 (95% CI, 2.78-4.18) for the group receiving 100 mg DCS (all P

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.

There is need for more knowledge concerning couple relationships and obsessive-compulsive disorder. In this study, patients with obsessive-compulsive disorder were interviewed in focus groups concerning how their illness influences relationship with their partner. The interviews were analyzed phenomenological. The results show that obsessive-compulsive disorder can cause mental and physical distance, the patient can feel monitored and pathologized by the partner’s accommodation and support, and the patient can monitor that the partner follows the rituals. The disturbed power balance can last even in periods with low symptom level. Power-related aspects should be emphasized in couple therapy for patients with obsessive-compulsive disorder.

Background Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. Methods Young Schema Questionnaire –Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) were measured in 40 OCD patients in a general outpatient clinic before and after group ERP, after 12-months and at extended follow-up. To analyze the predictors, a multiple regression analyses was conducted. Changes in overall EMS was analyzed by mixed models procedures. Results The major finding is that patients with high pre-treatment YSQ-SF total scores were less likely to respond to initial treatment or were more likely to relapse between post-treatment and the extended follow-up. The YSQ-SF total score at pre-treatment explained 10.5% of the variance of extended long-term follow-up outcome. The entire sample experienced a significant reduction in overall EMS over time with largest reduction from pre- to post-test. There were no statistically significant differences in total EMS change trajectories between the patients who were recovered at the extended follow-up compared to those who were not. Conclusion The results from the present study suggest that patients with higher pre-treatment EMSs score are less likely to recover in the long-term after receiving group ERP for OCD. A combined treatment that also targets early maladaptive schemas may be a more effective approach for OCD patients with elevated EMS who don’t respond to standard ERP. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

There is a lack of empirical studies investigating patients’ understanding of why they developed obsessive-compulsive disorder (OCD). In this article, we explore patients’ conceptualization of why they developed OCD and their understanding of the significance of having a theory about why they developed OCD. We utilized a hermeneutical-phenomenological approach to analyze and interpret the data. Focus group interviews were conducted with 15 individuals who had undergone group behavioral treatment for OCD for an average of 8.5 years ago. Four core categories were drawn from our analysis: (1) OCD as a coping strategy; (2) OCD as a result of family heritage; (3) comfort in understanding where one’s OCD comes from; and (4) ambivalence about focusing on causes in treatment of OCD. In conclusion, participants noted a range of potential psychosocial contributors to the development of their OCD symptoms. Of particular note were beliefs that OCD initially developed as a coping strategy for handling difficult life situations. Potential clinical and research-related implications of these findings are discussed. This article is an open access article. DOI:https://doi.org/10.15714/scandpsychol.6.e12

This focus group study explores the experiences of five partners of patients suffering from obsessive-compulsive disorder concerning how this disorder might influence couples’ relationships in the long-term. We find that the disorder might give rise to power struggles concerning “normality”, deprive couples of opportunities for rewarding fellowship during household chores and leisure time, and persistent analytic processes concerning predicaments of what to do. They also express a need for more help from the health services. The results might be of value to therapists in their daily work, and might have implications for future research on couple’s therapy involving this group.

Background Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. Methods Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. Results Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. Conclusions We conclude that the B4DT is an acceptable and potentially effective OCD-treatment. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Background Research is scarce with regard to the role of psychotic and schizotypal symptoms in treatment of obsessive-compulsive disorder (OCD). The aim of the current study was to investigate the occurrence and specificity of psychotic and schizotypal symptoms among non-psychotic OCD patients, and to examine whether such symptoms was associated with response to exposure and response prevention (ERP), and whether ERP for OCD had an impact on psychotic and schizotypal symptoms. Methods Non-psychotic OCD patients (n = 133) and a general non-psychotic psychiatric outpatient sample (n = 110) were assessed using self-report inventories before and after psychological treatment. Results Non-psychotic OCD patients did not report greater degree of psychotic or schizotypal symptoms than the control group. Psychotic and schizotypal symptoms were not associated with OCD symptoms before or after ERP. Psychotic and schizotypal symptom were significantly reduced following ERP. Conclusions Psychotic and schizotypal symptoms seem to be equally prevalent among non-psychotic OCD patients and non-psychotic psychiatric controls. These symptoms were more linked to depressive symptoms than OCD symptoms. In non-psychotic OCD patients, ERP seems sufficient in reducing OCD symptoms despite the presence of psychotic- and schizotypal symptoms, and reductions in psychotic- and schizotypal symptoms were observed following ERP.

According to interpersonal theory of personality, interpersonal behaviours can be causal and maintaining factors in emotional disorders. However, interpersonal styles have not yet been investigated in the treatment of obsessive compulsive disorder (OCD). The aim of the study was to investigate interpersonal style in OCD. The Inventory of Interpersonal Problems – Circumplex was used to assess the interpersonal styles of 101 outpatients with OCD treated with cognitive behavioural therapy (CBT). Patients with OCD had more interpersonal problems than the healthy control group. However, the OCD group presented with slightly fewer interpersonal problems than a further comparison group of psychiatric outpatients. Interpersonal style did not predict improvement in OCD symptoms. Following CBT for OCD, there were small to moderate improvements in interpersonal problems. These changes remained stable at 12-month follow-up. Although the OCD group reported reduced interpersonal problems post-treatment, the group still experienced more submissiveness compared to healthy controls. Interpersonal problems in OCD appeared to be more attributable to comorbid conditions than to OCD-specific symptoms. Although patients with OCD were found to have interpersonal styles that might cause some problems, these were minimal at baseline and did not significantly affect OCD treatment outcomes. Interpersonal problems in this population might be more strongly related to depressive symptoms than to OCD-specific symptoms. CBT was associated with slight improvements in interpersonal problems.

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.

Evidence-based exposure and response prevention (ERP) treatment for obsessive-compulsive disorder (OCD) is not always easily accessible. Long distances from specialist treatment and other practical or motivational difficulties can interfere with ERP access and outcome. Delivery of ERP through telepsychology can help “fill the gap”. The current study included 30 patients with OCD who were randomized to 12 weeks of either videoconference-assisted ERP (VCT; N = 10), self-help ERP (S–H, N = 10), or a wait-list condition (W-L, N = 10). The VCT format included use of tablet-based videoconferencing sessions ( N = 6) or studio-based videoconference ( N = 4), as well as telephone calls. Patients rated the VCT format as natural and reported strong working alliances with their therapists. VCT treatment produced significantly greater reductions in obsessive-compulsive symptoms compared to the two control conditions. Treatment outcomes were similar to that of regular face-to-face ERP and improvements in symptom scores remained stable at follow-up. The study indicated that ERP for OCD can be delivered efficiently with videoconferencing technology along with telephone calls. The use of such technology in psychological treatment is likely to become more common in the future and it holds promise as a method to make evidence-based treatment more accessible.

This is the first study that explores whether early maladaptive schemas are related to treatment outcome for patients with obsessive-compulsive disorder (OCD). The sample consisted of 88 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory and Young Schema Questionnaire – Short Form were administered before and after treatment. Regression analyses using post-treatment Y-BOCS as the dependent variable indicated that higher scores on the abandonment schema at pre-treatment were related to poor outcome and explained 7% of the variance in symptoms at post-treatment. Higher scores on the self-sacrifice schema at pre-treatment were related to good outcome and explained 6% of the variance in obsessive-compulsive symptoms at post-treatment. During treatment, only changes in the failure schema were significantly related to good outcome and explained 18% of the variance in symptoms at post-treatment.

The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy for OCD patients in a community-based, general Norwegian outpatient clinic. The sample consisted of 54 patients diagnosed with OCD. The Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory (STAI-S) were administered before treatment, after treatment and at 3- and 12-month follow-ups. Analyses with mixed models for repeated measurements showed that group behavioural therapy offered to OCD patients significantly improved ratings of obsessive–compulsive symptoms, depression and anxiety. These improvements were maintained at 3- and 12-month follow-ups and an additional reduction in obsessive–compulsive symptoms was observed from post-treatment to 3-month follow-up. However, the delayed effect of therapy was no longer present at 12-month follow-up. The results also revealed that the patients had a lower chance for an increased outcome category (e.g. from unchanged to improved or recovered) with high scores on STAI-S at the given observation times (post-treatment, 3- and 12-months follow-ups). Depressive symptoms (BDI) at post-treatment and follow-ups had no significant influences on the three categories of outcome for OCD. In conclusion, the results indicate that behavioural group therapy can successfully be delivered to patients with considerable comorbidity in a real world setting conducted by therapists with limited training in the CBT.