Neurocognitive performance in the context of acute symptom reduction in OCD: Treatment effects and the impact of BDNF.

BACKGROUND: Obsessive-compulsive disorder (OCD) has been associated with neurocognitive impairments. The present study examined the effect of treatment on neurocognitive performance in OCD and the relationship between neurocognitive change and symptom change. The present study also examined polymorphisms influencing brain derived neurotrophic factor (BDNF) as predictors of neurocognitive change. METHOD: Treatment-seeking participants with OCD (N = 125) were assigned to cognitive behavioural therapy (CBT) alone, CBT combined with regular physical exercise, exercise alone, or a waitlist control group. Measures of OCD symptom severity and a neuropsychological battery were completed pre- and post-treatment. Blood or saliva samples were used to genotype the BDNF Val66Met polymorphism. RESULTS: OCD symptom severity was not cross-sectionally associated with neurocognitive performance. Several neurocognitive measures improved over treatment. The BDNF Val66Met polymorphism was significantly associated with worse performance on the Stroop test but did not significantly predict change in neurocognitive performance over time. LIMITATIONS: Limitations include lack of a healthy control group. CONCLUSION: Improvement in neurocognitive performance corresponded to symptomatic improvement and was independent of the BDNF Val66Met genotype.

The Relationship of Rumination, Worry and OCD Symptoms During Technology Supported Mindfulness Therapy for OCD.

BACKGROUND: In this study, we re-examined data from a previous randomized controlled trial investigating 'technology supported mindfulness' (TSM)-an 8-week treatment intervention for individuals experiencing OCD. The current analysis involves an examination of the longitudinal relationships between rumination, worry and OCD symptom changes during mindfulness treatment, in comparison to a waitlist control. METHODS: Participants experiencing OCD (n = 71) were randomly assigned to 8 weeks of (1) TSM or (2) waitlist control. We tested the extent to which rumination (using the Ruminative Response Scale) and worry (using the Penn State Worry Questionnaire) are associated with OCD symptom changes during the acute phase of treatment, concurrently (i.e., within the same longitudinal model). RESULTS: Generalized linear model (GLM) results indicated a significant time (week 1 vs. week 8) by condition interaction involving decreased rumination in the TSM condition: F(1, 61) = 13.37, p = 0.001, partial η2 = 0.18 and observed power = 0.94. A second GLM demonstrated decreased worry in the TSM condition: F(1, 69) = 37.34, p = 0.001, partial η2 = 0.35 and observed power = 0.83. Longitudinal 'latent difference' structural equation analyses demonstrated a cross-lagged association between worry (but not rumination) and OCD symptom changes. CONCLUSIONS: Individuals in the TSM condition experienced greater reductions in rumination and worry during 8 weeks of TSM treatment compared to the waitlist control, and reduced worry predicted subsequent OCD symptom reduction.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness.

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

The effect of aerobic exercise alone and in combination with cognitive behavioural therapy on obsessive compulsive disorder: A randomized control study.

PURPOSE: Cognitive behavioural therapy (CBT) has been found to be an effective treatment for OCD, but there remains a significant proportion of individuals who fail to show a treatment response. Aerobic exercise has previously been associated with decreases in anxiety and depression, as well as improvements in OCD symptoms in small-scale studies. The purpose of the present research was to use a randomized control trial design to examine the effects of exercise alone and in combination with CBT, on OCD symptoms and secondary symptoms. METHOD: 125 participants were randomly assigned to one of four treatment groups: waitlist control, exercise, CBT, and CBT with exercise. OCD symptom severity was measured at four points over the course of treatment, secondary outcome measures were gathered at three points over treatment. RESULTS: CBT alone and combined with exercise was associated with significantly greater OCD symptom reduction than exercise alone or the control groups. Total exercise frequency predicted OCD symptom reduction in the groups in which exercise was measured. Group membership did not significantly predict reductions in secondary outcome measures. CONCLUSION: Exercise frequency, rather than the presence or absence of exercise, appears to predict OCD symptom reduction, as did participation in CBT.

The Impact of Group Feedback on Self-Perceptions Following Videotape Exposure in CBT for Social Anxiety Disorder.

Video feedback following social anxiety exposures improves self-perceptions. Clinical studies have not examined whether feedback from group members has incremental benefit beyond that of viewing the tape itself. Sixty-seven individuals with social anxiety disorder completed videotaped exposure during group based cognitive behavior therapy (CBT). After participants viewed their taped exposure, group members and therapists gave feedback. Participants completed ratings of anxiety and performance before and after taping their exposure, after viewing the video themselves, and after receiving group feedback. Appraisal of social concerns were assessed after taping, viewing, and group feedback. There were significant improvements in anxiety, performance, and decreased social concerns across time points. Comparing only the time points of after viewing and after receiving group feedback, the same pattern emerged for anxiety, performance, and appraisal of social concerns, with moderate to large effect sizes. Group feedback led to ratings that exceeded their own initial evaluation of their video. Video feedback in group CBT that also includes feedback from others may improve clinical outcomes.

Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder.

Intolerance of uncertainty (IU) is a key construct in generalized anxiety disorder (GAD), but little is known about the concurrent and temporal patterns of associations between IU and GAD symptom severity during treatment. In addition, most of the extant literature focuses on IU as a unidimensional construct, whereas some researchers conceptualize IU as being comprised of two dimensions, inhibitory and prospective IU. Ninety individuals with GAD completed measures of IU and worry severity at pre-treatment, session 4, session 8, and end of treatment (session 12), during group-based cognitive behavior therapy (CBT) for GAD. Longitudinal multilevel modeling showed that IU predicted worry severity concurrently, but not prospectively over time; this pattern of associations was found with the total IUS score and the inhibitory (but not prospective) subscale score. Further, the relationship between IU total scores and worry severity became stronger over time. The relationship between inhibitory (but not prospective) IU and worry also became stronger over time. When the order of the variables in the model was reversed, worry severity also predicted concurrent but not future IU. Therefore, change in IU is associated with change in worry throughout the course of CBT, particularly as treatment progresses, though its directional association as a cause and/or effect remains unclear.

Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play?

OBJECTIVE: Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively. METHOD: One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events. RESULTS: Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity. CONCLUSION: Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.

A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression.

Mindfulness-based interventions (MBIs) have emerged as clinically effective interventions for anxiety and depression although there are significant barriers to their access in the general population. The present study examined the effectiveness of a 5-week abbreviated mindfulness-based cognitive therapy (MBCT) intervention for a physician-referred, treatment-seeking, community sample (N = 54) with mood and/or anxiety symptom burden. Treatment effects demonstrated significant reductions in mood and anxiety symptom severity and significant increases in general well-being. Observed effect sizes were generally large, with high response and remission rates. The present study offers preliminary support that an abbreviated MBCT protocol can offer large treatment effects for decreasing mood and anxiety symptoms and could potentially offer an effective population-level strategy to improve cost-effectiveness and access to care.

Technology supported mindfulness for obsessive compulsive disorder: The role of obsessive beliefs.

The current study examined the association of OCD symptoms and OCD belief domains, for individuals engaged in Technology Supported Mindfulness training (TSM) using an EEG-based biofeedback device (called "Muse") that permits individuals to engage in home based mindfulness meditation practices. In this randomized controlled study, treatment-seeking participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the "Muse" device, or 2) wait list control. At weeks 1, 4, and 8, participants completed self-report measures of OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale) and OCD beliefs (OBQ; OCCWG, 2005). Latent Difference Score (LDS) models indicated that there was no significant longitudinal relationship between OBQ "Responsibility/Threat" (OBQ R/T) scores and OCD symptoms. The analysis of OBQ "Perfectionism/Certainty" (OBQ P/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ P/C and vice versa. The analysis of OBQ "Importance/Control of Thoughts" (OBQ I/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ I/C and vice versa. The analysis of OBQ domains and EEG derived attentional changes demonstrated a significant association between OBQ P/C and Alpha band frequencies. These results clarify the association of OBQ belief domains, OCD symptom change and EEG derived indicators of attention during TSM.

Technology supported mindfulness for obsessive compulsive disorder: Self-reported mindfulness and EEG correlates of mind wandering.

Cognitive Behavior Therapy (CBT) incorporating Exposure with Response Prevention (ERP) is the most efficacious treatment intervention for Obsessive Compulsive Disorder (OCD); however, there is a growing literature indicating that mindfulness based approaches can be beneficial in terms of managing OCD symptoms. The current study examined the potential benefits of using a consumer grade EEG-based biofeedback device (called "Muse") that permits individuals to engage in mindfulness meditation practices while at home. In this randomized controlled study, participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the "Muse" device, or 2) waitlist control. At weeks 1, 4, and 8, participants completed a five minute "open monitoring" practice while EEG data was recorded, and they completed self-report measures of mindfulness (FFMQ: Five Factor Mindfulness Questionnaire) and OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale). Latent Difference Score (LDS) models demonstrated that the FFMQ "Non-Reactivity" facet and EEG-derived correlates of "Mind Wandering" (i.e., alpha, beta, but not delta or theta band power) were temporally associated with subsequent changes in YBOCS symptom scores. Participants in the Muse group (in comparison to the control group) experienced increased FFMQ "Non-Reactivity" and decreased mind wandering (increased alpha and beta band power), and in each case, these variables were associated with subsequent OCD symptom improvement. These results suggest that technology supported mindfulness training for OCD is associated with improvements in OCD symptoms, mindfulness and decreased mind wandering.

Excessive reassurance seeking in depression versus obsessive-compulsive disorder: Cross-sectional and cognitive behavioural therapy treatment comparisons.

Excessive reassurance seeking (ERS) has been hypothesized as an important maintenance factor in depression and obsessive compulsive disorder (OCD). The present study examined the types of ERS in depression and OCD, the effects of CBT on ERS, predictors of ERS reduction, and the relation between ERS reduction and symptom change. METHOD: Treatment-seeking participants diagnosed with a depressive disorder (N = 361) or OCD (N = 156) completed the Reassurance Seeking Scale (RSS) and symptom measures before and following CBT treatment. Measures of intolerance of uncertainty and distress tolerance were completed pre-treatment as potential predictors of ERS change. RESULTS: Individuals with depression demonstrated higher pre-treatment ERS related to social attachment compared to those with OCD. ERS significantly decreased over treatment in both groups and change in ERS predicted symptom change among both OCD and depression groups. Higher pre-treatment intolerance of uncertainty significantly predicted less ERS change regardless of diagnosis. Distress tolerance was not associated with ERS changes. CONCLUSION: ERS is significantly related to symptom severity cross-sectionally as well as over treatment in depression and OCD, though types of ERS may differ. Higher intolerance of uncertainty may impede the reduction of ERS in CBT.

Preliminary Investigation of a Novel Cognitive Behavioural Therapy Curriculum on the Wellbeing of Middle Schoolers.

OBJECTIVES: A number of school-based interventions for preventing and attenuating symptoms of anxiety and depression in youth have been developed worldwide but evidence of their effectiveness is mixed. None of these curricula stem from existing children's literature, however, the Harry Potter (HP) series has been identified as potentially imparting Cognitive Behavioural Therapy concepts. METHODS: This study aimed to broadly capture, at an interim stage, the feasibility of a pilot HP curriculum aimed at imparting CBT skills to middle-schoolers in order to inform full development of the curriculum. The study design further included a non-randomized, Group (HP; Control) by Time (Baseline, Post-Intervention, Follow-up) mixed factorial approach retrospectively examining change in scores on a "Well-Being and Resiliency Survey" (WBRS) which assessed multiple symptomatic and social domains. RESULTS: In total, 232 grade seven and eight students participated in the curriculum over two years with no dropouts. Compared to 362 controls, there were no significant differences in WBRS scores between groups at post or one-year follow-up. CONCLUSIONS: This pilot study demonstrated the feasibility of rapid and broad implementation of the intervention. Preliminary analyses showed no indication of effectiveness which may be the product of the intervention being in an interim stage during the study period and/or the retrospective design and limitations in data quality. Specifically, these results suggest that the WBRS may be a suboptimal instrument for measuring the effectiveness of this intervention. A prospective trial of the complete, revised curriculum with validated measures is required to provide an adequately assessment of its impact.

OBJECTIFS: Un certain nombre d'interventions en milieu scolaire visant à prévenir et à atténuer les symptômes d'anxiété et de dépression chez les adolescents ont été mises au point dans le monde, mais les données probantes de leur efficacité sont partagées. Aucun de ces programmes d'études n'est issu de la littérature pour enfants existante, pourtant, la série des Harry Potter (HP) a été reconnue transmettre potentiellement des concepts de la thérapie cognitivo-comportementale (TCC). MÉTHODES: La présente étude visait à appréhender largement, à un stade préliminaire, la faisabilité d'un programme pilote HP destiné à transmettre des compétences de TCC aux élèves de premier cycle du secondaire afin d'éclairer l'élaboration complète du programme. La méthode de l'étude comprenait en outre un groupe non randomisé (HP, témoin) une chronologie (ligne de départ, post-intervention, suivi), une approche factorielle mixte examinant rétrospectivement le changement des scores à un « Sondage sur le bien-être et la résilience ¼ (SBER) qui évaluait les multiples domaines symptomatiques et sociaux. RÉSULTATS: En tout, 232 élèves de 7e et de 8e année ont participé au programme durant deux ans sans abandons. Comparativement aux 362 témoins, il n'y avait pas de différences significatives des scores de SBER entre les groupes au suivi d'un an ou après. CONCLUSIONS: Cette étude pilote a démontré la faisabilité de la mise en œuvre rapide et élargie de l'intervention. Les analyses préliminaires n'ont indiqué aucune efficacité qui puisse être le produit du stade préliminaire de l'intervention durant la période de l'étude et/ou de la méthode rétrospective et des limitations de la qualité des données. Spécifiquement, ces résultats suggèrent que le SBER peut être un instrument sous-optimal pour mesurer l'efficacité de cette intervention. Un essai prospectif du programme complet révisé avec des mesures validées est nécessaire pour obtenir une évaluation adéquate de son effet.

Neuropsychological performance across symptom dimensions of obsessive-compulsive disorder: a comment on the state and critical review of the literature.

Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, with multiple symptom presentations. Delineating the neuropsychological characteristics associated with previously identified symptom clusters may therefore be useful in assisting to better define symptom subtypes of OCD.Areas covered: This review summarizes the existing literature on the assessment of neuropsychological performance in symptom-based dimensions of OCD. Results of 23 studies are described and the methodological issues and challenges present in this body of literature are discussed.Expert opinion: The current state of the literature precludes a meaningful meta-analysis of cognitive dysfunction across the breadth of symptom dimensions of OCD. This is due primarily to significant methodological differences observed between studies, both in terms of neuropsychological measures and symptom subtyping methods employed, and any resulting meta-analytic results would be biased by varying quality of evidence. Future studies addressing these limitations should include more consistent neuropsychology measures and methods of classifying OCD symptoms with the aim of reproducing the results of previous research to identify more concrete patterns of neuropsychological performance across dimensions; best practices and alternative approaches are discussed.

Filling the Gap for Obsessive-Compulsive Disorder Services in Canada: Implementing an Intensive Care Program.

Obsessive-compulsive disorder (OCD) is a significant psychiatric illness that can impact an individual in terms of their quality of life, functional abilities, and interpersonal relationships. Until recently, services for individuals with severe symptoms of OCD were limited within Canada. The Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences Centre in Toronto, Canada, recently launched an intensive services program for individuals with severe symptoms of OCD. This article provides an overview of the steps that were taken to develop this program. Methods involved incorporation of information gathered from both service users and service providers of these models of treatment within North America and beyond. This article provides a potential treatment model for residential psychiatric treatment that can be applied to OCD and possibly other severe treatment refractory psychiatric illnesses in terms of methods used and generalizable key ingredients.

Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program.

Background: Obsessive-Compulsive Disorder (OCD) is a psychiatric illness that can result in debilitating symptoms and functional impairment. Until recently, individuals with severe OCD symptoms have not received appropriate services within the Canadian healthcare system. The Frederick W. Thompson Anxiety Disorders Centre launched an Intensive Services Residential treatment programme for OCD in July 2017 to meet the needs of the Canadian population. This paper sets out to demonstrate the effectiveness of this programme.Methods: This study incorporated quantitative and qualitative data collection. Quantitative data were analysed using paired sample t-tests while qualitative data was transcribed and coded for emerging themes.Results: Beneficial changes in symptomatology were found. Client narrative emphasised the importance of exposure response prevention (ERP), creation of an OCD community as well as enhanced functionality in clients' lives. Clients also commented on why they believed the treatment worked and points of potential improvement for discharge planning and programme organisation.Conclusions: This study adds to the growing body of evidence regarding the importance of intensive services for individuals experiencing severe symptoms of OCD. Enhancing accessibility to services and ensuring ongoing maintenance of gains will be important next steps in ensuring long-term recovery for individuals with severe symptoms of OCD.Key pointsIntensive services treatment for OCD has been found to be beneficial for clients and this paper demonstrates the first time this has been seen within a Canadian programme.Treatment provided decreased OCD severity and increased functionality and quality of life.Clients cited exposure and response prevention work as a key ingredient in their recovery.Our programme is always in an ongoing state of quality improvement, ensuring client engagement and satisfaction.

Reassurance seeking in the anxiety disorders and OCD: Construct validation, clinical correlates and CBT treatment response.

BACKGROUND: Reassurance seeking has been hypothesized to be a key factor in the maintenance of anxiety and obsessive-compulsive disorders according to contemporary cognitive-behavioural therapy (CBT) approaches. The present study sought to examine the structure, clinical correlates, and malleability of reassurance seeking in the context of CBT treatment. METHODS: Treatment-seeking participants (N = 738) with DSM-IV-TR (American Psychiatric Association, 2000) panic disorder with agoraphobia (PD/A), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) completed the Reassurance Seeking Scale (RSS) with other symptom measures prior to and following CBT treatment. RESULTS: A confirmatory factor analysis supported a three factor solution: the need to seek excessive reassurance regarding decisions, attachment and the security of relationships, and perceived general threat and anxiety. The RSS was moderately correlated with general measures of anxiety and depression as well as disorder-specific symptom scales. Further, CBT was found to produce changes in reassurance seeking across CBT treatments and these reductions were significantly associated with disorder-specific clinical improvement. CONCLUSION: Reassurance seeking appears to be a common factor across anxiety disorders and its reduction in CBT treatment is associated with improved clinical outcomes.

Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology.

PURPOSE: Post-event processing (PEP) is posited to be an important factor in the maintenance of social anxiety symptoms. Previous research has demonstrated that general PEP tendencies are sensitive to treatment. However, it remains unclear how momentary PEP following social interactions changes over the course of treatment for social anxiety disorder. The purpose of the present study was to examine how both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome. METHOD: Participants (N = 60) with social anxiety disorder were enrolled in group cognitive behavioural therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment. RESULTS: Both general and momentary PEP decreased over the course of treatment. Decreases in both types of PEP predicted lower social anxiety symptom severity following treatment. CONCLUSION: The results of the study demonstrate that momentary experiences of PEP can be influenced by treatment, and can in turn impact treatment outcome. The findings have significant clinical and theoretical implications.

What Drives OCD Symptom Change During CBT Treatment? Temporal Relationships Among Obsessions and Compulsions.

Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.

Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting.

OBJECTIVES: Exposure and response prevention (ERP) remains the most empirically supported psychological treatment for obsessive compulsive disorder (OCD). Clinical guidelines recommend the addition of cognitive approaches to ERP although the presumed additive benefits have not been directly tested. The aim of this was to compare a treatment that integrated cognitive therapy with ERP (ERP + CT) to traditional, manualized ERP to test the additive benefits. DESIGN: A longitudinal, randomized control trial design was used. METHODS: Participants (N = 127) with OCD were randomly assigned to receive individual outpatient ERP or ERP + CT. Obsessive-compulsive symptom severity measures were completed pre- and post-treatment and at 6-month follow-up. RESULTS: While both conditions led to significant symptom and obsessive belief reduction, ERP + CT led to significantly greater symptom and belief reduction as compared to ERP across all main symptom presentations of OCD. Based on a priori definitions of effectiveness, more patients in ERP + CT compared to the ERP group were also deemed treatment responders. CONCLUSIONS: The results of this study suggest that cognitive therapy can be readily integrated with ERP to improve clinical outcomes beyond ERP alone. PRACTITIONER POINTS: Both ERP and ERP + CT were effective, however a course of ERP + CT was significantly more effective at reducing symptoms of OCD than the ERP treatment condition. Significantly more participants who received ERP + CT experienced clinically significant change in OCD symptoms compared to those who received ERP. OCD symptom dimension did not significantly impact response to either ERP or ERP + CT treatments.

A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes.

To systematically review and meta-analyze research investigating the association between maternal anxiety during pregnancy and outcomes for mother and baby following the immediate delivery period. MEDLINE, Medline In-Process & Other Non-Indexed Citations, PsycINFO, Embase, CINAHL, and the Cochrane library were searched. English-language, prospective studies providing data on outcomes following delivery in women with and without antenatal anxiety (defined by clinical diagnosis or score on validated scale) were included. Three-hundred-fifty-eight articles were retrieved and 13 were included. Titles and abstracts were screened; two reviewers independently reviewed full text articles, conducted quality assessments, extracted, and checked the data. Where available for > 2 studies, random effect meta-analysis was conducted and heterogeneity was quantified. Subanalyses explored moderators, regardless of heterogeneity, including type of anxiety assessment and timing, among others. There were two outcomes that were amenable to meta-analysis. Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR] = 2.64, 95% CI 2.02-3.46; 8 studies), regardless of restricting analyses to those studies controlling for prenatal depression (2.45, 1.77-3.39; 6 studies). Associations were also significant when PPD was measured at 1-3 months (2.57, 1.94-3.40; 7 studies) and 6-10 months (4.42, 1.45-13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53-0.74; 5 studies). Antenatal anxiety is associated with PPD up to the first 10 months, independent of prenatal depression, and with lower odds of breastfeeding.