Symptom Severity Changes in Obsessive-Compulsive Patients during COVID-19 Pandemic Are Associated with Shorter Illness Duration and Benzodiazepine Use: Possible Evolutionary Advantage of a Psychiatric Disorder (preprint)

Obsessive–compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insight of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown, with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need of additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances, while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and extraordinary supply of essential resources.

COVID-19-Related Stressors and Psychophysical Health Conditions Among Italian University Students: A Post Pandemic Insight (preprint)

The COVID-19-medical emergency has ended worldwide, yet there is still a need to evaluate the psychological impact of these years of unprecedented changes on students’ life. Methods: This study aims to assess and compare COVID-19-related stressors (Relationships-and-Academic-Life; Isolation; Fear-of-Contagion) and psychophysical symptoms reported by university students in April-2020, April 2021, and April 2022. The predictive role of COVID-19-related stressors on psychophysical symptoms within each time was also tested. Data were collected among 637 university students in April-2020 (n = 197), April-2021 (n = 200), April-2022 (n = 240). Results: In April-2022, perceived Isolation and Fear-of-Contagion decreased from the peak registered in April-2021, but stress related to Relationships-and-Academic-Life remained noteworthy high. A sharp and ongoing increase in psychophysical symptoms was found, with more than 50% of students reporting clinical levels of Sleep-Disorders, Depression, Psychoticism, and Interpersonal-Sensitivity. In April-2022, students still perceiving stress related to Relationships-and-Academic-Life and Isolation were at risk for Anxiety, Somatization, and Sleep-Disorders, while those still perceiving stress related to Fear-of-Contagion were also at risk for Depression, Obsessive-Compulsive, and Psychoticism. Conclusion: Findings emphasized the long-lasting detrimental effects of the COVID-19-related stress. Interventions must pinpoint the complex post-pandemic adjustment process and their effects on university students' psychophysical health.

Anxiety and obsessive-compulsive disorder among undergraduate medial students in Syria during war and COVID-19: A cross-sectional study (preprint)

Introduction: Syria has been suffering war for 10 years and COVID-19 added particular stress to people. Medical students are more prone than general population to anxiety and obsessive-compulsive disorder (OCD) which we are going to assess in this study. Methods This is a cross-section study that used online questionnaires were distributed in Social Media groups that included medical students. They included demographics, Zung self-Rating Anxiety Scale (SAS) and Yale-Brown OCD Scale (YBCOS). Results Overall, 180 participants were included, of which, 67 (37.2%) were males. Females and interns had higher OCD scores compared with males and more junior students p<0.05. OCD scores were not associated with social status, work, smoking, residency status, or having chronic diseases. Factors that were associated with higher anxiety scores were female gender and smoking p<0.05. In contrast, anxiety had no significant association with social status, residence status, academic year, work, and chronic diseases. Anxiety scores were not correlated with the consumption of tea, coffee, mate, or alcohol. OCD scores were also not correlated with coffee, mate, or alcohol consumption, but they were significantly correlated with tea consumption. When using regression, OCD and anxiety were associated with only sex, smoking and with each other. Conclusion These numbers were not higher than most of other studies. Further studies are needed for further evaluation to determine the cause whether it was from war having equal effect on mental health or COVID did not affect people as much in Syria.

The impact of COVID-19 pandemic and lockdown on emergency psychiatry department admissions (preprint)

Background: This study aimed to explore the impact of coronavirus disease 2019 pandemic and lockdown period (LP) measures on patients’ visits to psychiatric emergency department (PED) of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School. Methods: We conducted a retrospective cohort study comparing the number and characteristics of patients during the initial lockdown with visits in the pre- and post-lockdown months. We also investigated the number of monthly PED visits and hospitalizations between March 11, 2020-2021 and compared it to the same period in 2019 and between March 2021-2022. Results: PED visits in the initial LP in Istanbul increased by 109% compared to the pre-lockdown months in the previous year. Anxiety and depressive disorders were responsible for most of this increase. The decline in PED visits was 3.1% and 42% during the first and second year of the pandemic, respectively; however, among the major diagnostic categories, we found that the rates of anxiety, depressive disorders, and OCD increased significantly in the first year, while psychotic disorders declined and bipolar disorders remained the same. In the second year, there was a trend toward pre-pandemic year ratios. Conclusion: The present findings highlight the immediate and long-term effects of the COVID-19 pandemic and lockdown measures on patients’ admission to the PED.

Effects of strict COVID-19 lockdown on patients with obsessive-compulsive disorder compared to a clinical and a nonclinical sample.

BACKGROUND: Symptoms of obsessive-compulsive disorder (OCD) have been reported to increase during the COVID-19 lockdowns because of the hygiene requirements related to the pandemic. Patients with adjustment disorder (AD) may, in turn, represent a vulnerable population for identifiable stressors. In this study, we aimed at assessing potential symptoms changes in OCD patients during the lockdown in comparison with AD patients as well as versus healthy controls (HC). METHODS: During the COVID-related lockdown, we enrolled 65 patients and 29 HC. Participants were tested with four clinical rating scales (Yale-Brown obsessive-compulsive scale and Brown Assessment of Beliefs Scale for OCD patients; Beck Depression Inventory-II and State-Trait Anxiety Inventory-Y for each group) that had been also administered just before the Italian lockdown. RESULTS: Our results showed that during the lockdown: (i) the symptoms of depression and anxiety increased in all groups, but this increase was most pronounced in HC (p < 0.001); (ii) OCD symptoms severity did not increase, but the insight worsened (p = 0.028); (iii) the proportion of OCD patients showing hygiene-related symptoms increased (p = 0.031 for obsessions of contamination), whereas that of patients with checking-related symptoms decreased. CONCLUSIONS: The lockdown-induced psychological distress apparently changed the characteristics and the pattern of OCD symptoms expression but not their overall severity. This evidence confirms the heterogeneity and changing nature of OCD symptoms, strongly depending on the environmental circumstances.

Understanding the support needs of parents of children with obsessive-compulsive disorder: a qualitative descriptive study in the UK.

INTRODUCTION: Caring for a child with obsessive-compulsive disorder (OCD) can be extremely difficult, yet evidence-based support strategies for parents/carers are limited. A detailed understanding of parent support needs is an important first step in intervention development and qualitative research with this focus is currently lacking. In this study, the viewpoints of parents and professionals were used to understand support needs and preferences when caring for a child with OCD. This qualitative descriptive study formed part of a wider UK-based project aimed at developing better support for parents of children with OCD. METHOD: Individual semi-structured interviews (and an optional one-week journal) with a purposive sample of parents of children and young people (CYP) with OCD, aged 8-18, and focus groups (or individual interviews where preferred) with a purposive sample of professionals supporting CYP with OCD. Data comprised transcripts of audio-recorded interviews and focus groups, and text from journals. Analysis was informed by the Framework approach involving inductive and deductive coding, supported by NVivo 12.0 software. Co-production methods were adopted throughout the research process, including the involvement of a parent co-researcher and charity collaborators. RESULTS: Interviews were undertaken with 20 parents, of which 16 completed a journal. Twenty-five professionals took part in a focus group or interview. Five key themes relating to parent support challenges and support needs/preferences were identified (1) Coping with the impact of OCD; (2) Getting help for my child; (3) Understanding parents' role; (4) Making sense of OCD; (5) Joined-up care. CONCLUSION: Parents caring for children with OCD have clear caregiver support needs which are currently not being met. Through triangulation of parent and professional accounts, this study has identified parent support challenges (e.g., emotional impact of OCD, visibility of caring role, misunderstanding about OCD) and support needs/ preferences (e.g., headspace/respite, compassion/sensitivity, guidance on accommodation) to lay the vital foundations for the development of effective parent support interventions. There is now an urgent need to develop and test an intervention to support parents in their caregiving role, with the aim of preventing and/or reducing their levels of burden and distress and ultimately, improving their quality of life.

Prevalence and predicors of COVID-centred obsessive compulsive disorder among Iranian COVID-19 recovered individuals: a Bayesian analysis.

BACKGROUND: The evidence on the psychological consequences of coronavirus 2019 mainly relates to general psychiatric problems, and a few studies have reported the incidence and predictors of obsessive-compulsive disorder. OBJECTIVE: To determine the prevalence of obsessive-compulsive disorder (OCD) and its predictors in Iranian COVID - 19 recovered individuals at 3-6 months, 6-12 months, and 12-18 months after recovery. METHOD: In this cross-sectional analytical study, 300 participants were randomly selected based on the inclusion criteria from three hospitals in three different regions of Tehran, Iran, and were assessed by the Clinical Demographic Information Questionnaire, the Obsessive Compulsive Inventory-Revised (OCI-R), the Depression, Anxiety and Stress Scale 21 (DASS21), The Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). The obtained data were analyzed with SPSS version 26. RESULTS: The results showed that the mean score of OCD is 30.58 ± 15.22, with a prevalence of 71% (n = 213). Female gender (BF = 0.50, p = 0.01), sleep disturbance (BF = 0.02, p = 0.001), PTSD (BF = 0.009, p = 0.0001), depression (BF = 0.0001, p = 0.0001), and stress (BF = 0.0001, p = 0.001) are the strongest predictors of the presence of OCD in recovered COVID - 19 individuals. CONCLUSION: OCD-like symptoms was observed in the majority of COVID - 19 recovered individuals with mild to moderate severity. In addition, the stated prevalence, severity, and significance varied according to sociodemographic and health inequalities.

Mental Health Problems and Coping Strategies of Medical Interns in Clinical Teaching Base During Epidemic Period - Data from China (preprint)

Background The COVID-19 pandemic has dealt a heavy blow to the mental health of tens of millions of people, with nearly 1 billion people living with a mental disorder worldwide and one person dying every 40 seconds from suicide [1]. On 5 May 2023, WHO declared the end of the global health emergency, but globally, more than 2.6 million new cases and more than 17 000 deaths have been reported in the past 28 days (10 April to 7 May 2023) [2]. There are new coronavirus positive cases around us from time to time, and many people are anxious about this. It shows that COVID-19 remains a global health threat. Therefore, we should pay attention to the mental health problems caused by the epidemic, especially the social vulnerable population who are in the front line of fighting the epidemic but have relatively weak self-prevention ability [3] -- medical interns. It's necessary to investigate their mental health status and explore coping strategies.Methods We administered the Symptom Checklist 90 (SCL-90) and Simplified Coping Style Questionnaire (SCSQ) to assess somatization symptoms and coping styles, respectively, and compared results to national norms for Chinese youth.Results The scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, terror, paranoia and psychosis of the interns were higher than those of the national youth group norm. The scores of somatization and phobia in female students were higher than those in male students, and the scores of each factor in undergraduate students were higher than those in college students, and the differences were statistically significant (P < 0.05). The score of negative coping style was positively correlated with the total score of negative factors of mental health (somatization, compulsion, depression, anxiety) (β=-0.569, P < 0.05). Positive coping style was negatively correlated (β = 0.899, P < 0.01).Conclusion During the epidemic period, the mental health level of interns in the base is lower than that of the national youth norm, and female and undergraduate interns are more serious. Positive coping style can reduce their mental health problems.

The relationship between fear of Covid-19 and obsessive-compulsive disorder.

BACKGROUND: The coronavirus pandemic and health measures related to it have led to an increase in mental health problems. The relatively high incidence of the disease and its mortality rate created anxiety in society. This study aimed to determine the prevalence of fear of the coronavirus (COVID-19) and its relationship with obsessive-compulsive disorder in patients who attended the outpatient clinic of Besat Hospital in Hamadan. METHODS: In this cross-sectional descriptive study, 320 patients who attended the outpatient clinic of Besat Hospital in Hamadan were selected by random sampling method in 2021. Data were collected using the Fear of the coronavirus (COVID-19) questionnaire and obsessive-compulsive disorder scale and analyzed using SPSS software (V16). They were analyzed using Pearson correlation coefficient and independent t-test. RESULTS: The mean ± SD age of the subjects was 34.14 ± 9.30 years and 65% of the study subjects were women. The mean ± SD score on the obsessive-compulsive disorder scale was 32.90 ± 19.87 and the mean ± SD score for fear of coronavirus was 16.82 ± 5.79. The contamination dimension of OCD had the highest score of 9.04 ± 5.46 and stealing had the lowest score of 0.10 ± 0.49. The mean fear of COVID-19 in people who had a history of obsessive-compulsive disorder before the quarantine was significantly higher than in those who did not have it (P = 0.002). Along with the increasing fear of coronavirus scale score, the score of obsessive-compulsive disorders increased except for the stealing dimension (P < 0.001). CONCLUSIONS: The results of the study showed that there was a moderate level of fear of COVID-19 among the study population. Also, a relatively high proportion of study subjects had a weak manifestation of OCD. It seems that two years after the beginning of the Covid-19 coronavirus pandemic, people have adapted to the conditions, and their fear of the disease is reduced.

Inflammatory neuropsychiatric disorders and COVID-19 neuroinflammation.

Neuropsychiatric sequalae to coronavirus disease 2019 (COVID-19) infection are beginning to emerge, like previous Spanish influenza and severe acute respiratory syndrome episodes. Streptococcal infection in paediatric patients causing obsessive compulsive disorder (PANDAS) is another recent example of an infection-based psychiatric disorder. Inflammation associated with neuropsychiatric disorders has been previously reported but there is no standard clinical management approach established. Part of the reason is that it is unclear what factors determine the specific neuronal vulnerability and the efficacy of anti-inflammatory treatment in neuroinflammation. The emerging COVID-19 data suggested that in the acute stage, widespread neuronal damage appears to be the result of abnormal and overactive immune responses and cytokine storm is associated with poor prognosis. It is still too early to know if there are long-term-specific neuronal or brain regional damages associated with COVID-19, resulting in distinct neuropsychiatric disorders. In several major psychiatric disorders where neuroinflammation is present, patients with abnormal inflammatory markers may also experience less than favourable response or treatment resistance when standard treatment is used alone. Evidence regarding the benefits of co-administered anti-inflammatory agents such as COX-2 inhibitor is encouraging in selected patients though may not benefit others. Disease-modifying therapies are increasingly being applied to neuropsychiatric diseases characterised by abnormal or hyperreactive immune responses. Adjunct anti-inflammatory treatment may benefit selected patients and is definitely an important component of clinical management in the presence of neuroinflammation.

Investigating the correlation between perceived stress and health anxiety with obsessive-compulsive disorder and quality of life during COVID-19 pandemic.

BACKGROUND AND AIMS: The present study aimed to investigate the correlation between perceived stress and health anxiety with obsessive-compulsive symptoms and quality of life during COVID-19 pandemic. METHODS: This cross-sectional study was performed in the general public in Isfahan and Bandar Abbas. 559 citizens were selected by convenience sampling. An online questionnaire was used to collect the data, which consisted of: short health anxiety inventory, perceived stress scale, world health organization quality of life questionnaire and Padua inventory. Data analysis was performed using SPSS-24 and Amos-21. RESULTS: There were significant positive correlations between health anxiety and perceived stress (r = 0/338), obsessive-compulsive symptoms and perceived stress (r = 0/16), obsessive-compulsive symptoms and health anxiety (r = 0/344). Also there were significant negative correlations between obsessive-compulsive symptoms and quality of life (r = - 0/21), health anxiety and quality of life (r = - 0/366), perceived stress and quality of life (r = - 0/715). CONCLUSION: health anxiety and perceived stress during COVID-19 affect the obsessive-compulsive symptoms and quality of life. Therefore, it is recommended to pay attention to these psychological disorders during this global crisis and take actions to prevent and treat them.

Obsessive Compulsive Disorders in the Primary Care Setting.

Mental health is a very important component of whole health because the body, mind, and spirit are woven together to create the fabric of a person's life. Many people in the United States and globally are living with mental health challenges, and it seems that much more attention has been given to anxiety-related mental health conditions in the past few years due to the coronavirus disease 2019 pandemic. The pandemic may certainly have accelerated the onset of mental health conditions for some who were already predisposed, whether it be to depression, anxiety, psychosis, or obsessive-compulsive disorder, to name a few.

Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect. METHODS: FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages. RESULTS: Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation. CONCLUSIONS: tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step. TRIAL REGISTRATION: ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.

Characterising subgroups of people with severe COVID anxiety by latent profile analysis. (preprint)

Background: Severe COVID anxiety describes people whose experiences of the COVID-19 pandemic are overwhelming, and have lead to patterns of behaviours that add little protective benefit but are at the expense of other priorities in life. It appears to be a complex social and psychological phenomenon, influenced by demographic and social factors. Identifying subgroups of people with severe COVID anxiety would better place clinicians to assess and support this distress where indicated. Methods: Measurement tools assessing depression, generalised and health anxiety, obsessive-compulsive symptoms, personality difficulty and alcohol use from 284 people living in United Kingdom with severe COVID anxiety were explored with latent profile analysis. Further analyses examined the associations of identified clusters with demographic and social factors and daily functioning, quality of life and protective behaviours. Results: A model with 4 classes provided the best fit. Distinct patterns of psychopathology emerged which were variably associated with demographic factors and COVID behaviours. Limitations: Given the complex aetiology of COVID anxiety a number of factors which might better cluster subgroups are likely to have gone uncollected. Moreover, using data collected at a single time-point limits these results ability to conclude whether observed relationships were the product of the pandemic or longstanding. Conclusions: People living with severe COVID anxiety are a heterogenous group. This analysis adds to evidence that certain health behaviours and demographic factors are inextricably linked to poor mental health in people with COVID anxiety, and that targeting health behaviours with specific intervention might be beneficial.

Incidence rates of treated mental disorders before and during the COVID-19 pandemic - a nationwide study comparing trends in the period 2015 to 2021 (preprint)

Background: There is a concern that exposure to psychosocial stressors during the COVID-19 pandemic may have led to a higher incidence of mental disorders. Thus, this study aimed to compare trends in incidence rates of depressive disorder, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders in primary- and specialist health care before (2015-2019) and during the COVID-19 pandemic (2020-2021). Methods: We used aggregated population registry data to calculate incidence rates of mental disorders from primary (The Norwegian Control and Payment of Health Reimbursement Registry (KUHR)) and specialist (The Norwegian Patient Registry (NPR)) health care. The analyses included all Norwegian residents aged 18-65 during the study period. Incident cases were defined as having no previous registration with the same mental disorder in KUHR (from 2006) or NPR (from 2008). We used linear prediction models and mean models to compare incidence rates and test trends before and during the pandemic. Results: During the pandemic, the incidence rates among women were higher or as predicted for OCD in specialist care and for eating disorders in both primary and specialist care. Incidence rates for depression and phobia/OCD among both genders in primary care and phobic anxiety disorders among both genders in specialist care were lower or as predicted. Conclusion: The COVID-19 pandemic may have led to more women needing treatment for OCD and eating disorders in the Norwegian population. The decreased incidence rates for some disorders might indicate that some individuals either avoided seeking help or had improved mental health during the pandemic.

Living alone and mental health: parallel analyses in longitudinal population surveys and electronic health records prior to and during the COVID-19 pandemic (preprint)

Objectives: To describe the mental health gap between those who live alone and those who live with others, and to examine whether the COVID-19 pandemic had an impact on this gap. Design: Ten population based prospective cohort studies, and a retrospective descriptive cohort study based on electronic health records (EHRs). Setting: UK Longitudinal population-based surveys (LPS), and primary and secondary care records within the OpenSAFELY-TPP database. Participants: Participants from the LPS were included if they had information on living status in early 2020, valid data on mental ill-health at the closest pre-pandemic assessment and at least once during the pandemic, and valid data on a key minimum set of covariates. The EHR dataset included 16 million adults registered with primary care practices in England using TPP SystmOne software on 1st February 2020, with at least three months of registration, valid address data, and living in households of <16 people. Main outcome measures: In the LPS, self-reported survey measures of psychological distress and life satisfaction were assessed in the nearest pre-pandemic sweep and three periods during the pandemic: April-June 2020, July-October 2020, and November 2020-March 2021. In the EHR analyses, outcomes were morbidity codes recorded in primary or secondary care between March 2018 and January 2022 reflecting the diagnoses of depression, self-harm, anxiety, obsessive compulsive disorder, eating disorders, and severe mental illnesses. Results: The LPS consisted of 37,544 participants (15.2% living alone) and we found greater psychological distress (SMD: 0.09 (95% CI: 0.04, 0.14) and lower life satisfaction (SMD: -0.22 (95% CI: -0.30, -0.15) in those living alone pre-pandemic, and the gap between the two groups stayed similar after the onset of the pandemic. In the EHR analysis of almost 16 million records (21.4% living alone), codes indicating mental health conditions were more common in those who lived alone compared to those who lived with others (e.g., depression 26 and severe mental illness 58 cases more per 100,000). Recording of mental health conditions fell during the pandemic for common mental health disorders and the gap between the two groups narrowed. Conclusions: Multiple sources of data indicate that those who live alone experience greater levels of common and severe mental illnesses, and lower life satisfaction. During the pandemic this gap in need remained, however, there was a narrowing of the gap in service use, suggesting greater barriers to healthcare access for those who live alone.

Personalized exposure and ESM feedback versus exposure as usual for OCD: a study protocol for a randomized controlled trial (preprint)

Background This study aims to compare personalized exposure with response prevention (ERP) using experience sampling methodology-based feedback to ERP as usual in patients with obsessive-compulsive disorder (OCD). Personalized exposure will be provided screen-to-screen in an ecologically valid (real time and real place) context by means of a smartphone application. This app will also be used to collect both objective and subjective data by means of experience sampling methodology (ESM). This ESM-data will be used to identify triggers and protective factors for symptom severity, provide personalized feedback and optimize the effect of ERP. The primary goal of this RCT is to compare the effectiveness of personalized ERP to ERP as usual in the traditional context of a therapist’s room in patients with OCD in OCD symptom severity. Since both self-efficacy and experiential avoidance are known to influence symptom-severity in OCS, a secondary goal is to examine if a possible treatment effect is mediated by self-efficacy or experiential avoidance.  Methods This study involves a randomized controlled trial with 20 weekly sessions by 2 groups (ERP as usual versus personalized ERP), repeated measurements at baseline (T0), 5 weeks of treatment (T1), 10 weeks of treatment (T2), 15 weeks of treatment (T3), posttest at 20 weeks (T4), 6 weeks follow-up (T5), 3 months follow-up (T6), 6 months follow-up (T7) and a year follow-up (T8). A hundred and sixty patients with an OCD diagnosis according to DSM-5 criteria will participate. Half of the group will receive exposure with response prevention as usual, the other half will receive personalized exposure with response prevention with a smartphone application and personalized feedback sessions based on experience sampling data. Discussion This randomized controlled trial is the first to assess the influence of delivering ERP through video calling and the use of an ESM intervention on the symptom severity of OCD. Since the global pandemic COVID-19, the use of video calling to deliver psychological treatments has become more common, increasing the relevance of this study. Trial registration: ICTRP Trial NL8254 registered on 2019-12-24 url: https://trialsearch.who.int/Trial2.aspx?TrialID=NL8254