Oc dactiongrouptreatments

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OCD Action

Group Therapy presentation by Karina Lovell

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  • 1960’s
  • 3-13%
  • 1,2,3 &4
  • 1,2,3 &4
  • 1995
  • Problem solving
  • Problem solving
  • NOTES FOR PRESENTER
    Please refer to the NICE guideline and QRG (pages 10 and 11) for the full overview of treatment pathway
    Mild functional impairment: if the patient cannot engage in CBT (with ERP) or CBT (with ERP) is inadequate, consider:
    Moderate functional impairment:if inadequate response at 12 weeks, multidisciplinary review and consider:
    Severe functional impairment:if inadequate response at 12 weeks, or no response to SSRI or patient has not engaged in CBT, consider: (refer to MDT expertise in OCD for assessment and further planning next slide 15)
    Refer to QRG (page 10) and NICE guideline –
    Section 1.5.1 to 1.5.1.7
    The intensity of psychological treatment has been defined as the hours of therapist input per patient. By this definition, most group treatments are defined as low intensity treatment (less than 10 hours of therapist input per patient), although each patient may receive a much greater number of hours of therapy.
    CBT and ERP can be delivered in a variety of ways e.g. individual / group therapy, telephone, books and self-help.
  • Krone et al (1991) 36 patients in group programme
    DIRT 1 therapist
  • Oc dactiongrouptreatments

    1. 1. Group CBT for OCD Professor Karina Lovell
    2. 2. Aims of the workshop      Identify the recommended treatments for OCD (NICE guidelines) Identify how and where group treatment for OCD is incorporated into the NICE guideline Examine the evidence base for group CBT for OCD Examine the advantages and disadvantages for group CBT for OCD Examine how group therapy for OCD works in practice
    3. 3. The prevalence of OCD is estimated at: A 1-3% B 4-7% C 8-11% D 12-15%
    4. 4. NICE Guidelines do not recommend which treatment for OCD? A B CBT (with exposure and SSRI’s response prevention) C D Psychodynamic psychotherapy Group CBT
    5. 5. Which of the following modes of delivery have been tested with OCD: 1) Bibliotherapy 2) cCBT 3) Group CBT 4) Telephone A 1,2,3 & 4 B 1,3 & 4 C 1& 4 D 2,3 & 4
    6. 6. Which of the following low intensity interventions do NICE recommend: 1) cCBT 2) Brief individual CBT 3) Group CBT 4) CBT delivered by telephone A 1, 2, 3 & 4 B 1&2 C 2, 3 & 4 D 2&4
    7. 7. Nice guidelines determine low intensity treatments as less than how many therapist hours? A B 5 10 C D 15 20
    8. 8. The most common outcome measure used in treatment studies is the ? A B BDI OCC C CORE-OM D YBOC’s
    9. 9. In 1996 OCD was ranked as the ?th leading cause of disability A 8th B 9th C 10th D 11th
    10. 10. Obsessive compulsive disorder OCD is a major disorder is and under recognized public health problem.  10th leading cause of disability by WHO  Lifetime prevalence (1.9-3.0%)  There is evidence that without adequate treatment the disorder tends to have a chronic fluctuating course 
    11. 11. Obsessions Obsessions are repetitive, recurring thoughts, ideas, images or impulses that are experienced as intrusive and are usually distressing or anxiety provoking. Such thoughts are often centered on dirt and contamination, accidental harm, illness, aggression, sex, orderliness and perfection.
    12. 12. Compulsions Compulsions (rituals) are repetitive and intentional acts and serve to reduce anxiety the thoughts provoke. The person recognizes that their behavior is excessive or unreasonable.
    13. 13. NICE Guidelines   Obsessive compulsive disorder: core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder Published 2005
    14. 14. What is NICE?     National Institute for Health and Clinical Excellence Part of the NHS Established 1999 Produces Clinical Guidelines for the “appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales”
    15. 15. What does the NICE OCD/BDD guideline cover   Children, young people and adults with OCD/BDD – mild, moderate and severe functional impairment A stepped-care approach to recognition, assessment, treatment interventions, intensive treatment and inpatient services, discharge and re-referral Who is it aimed at?  Healthcare professionals who share in the treatment and care of people with OCD/BDD  Commissioners of services  Service users, families/carers
    16. 16. NICE recommendations identified as key priorities  All people with OCD should have access to evidence-based treatments: CBT including exposure and response prevention (ERP) and/or pharmacology  CBT (including ERP) should be offered in a variety of formats
    17. 17. Treatment options for adults with OCD Mild functional impairment Brief CBT (+ERP) < 10 therapist hours (individual or group formats) Moderate functional impairment Offer choice of: more intensive CBT (+ERP) >10 therapist hours or course of an SSRI Patient cannot engage in/CBT (+ERP) is inadequate Severe functional impairment Inadequate response at 12 weeks Multidisciplinary review Offer combined treatment of CBT (+ERP) and an SSRI
    18. 18. Interventions for OCD   Cognitive Behaviour Therapy (exposure and response prevention) Pharmacological (SSRI’s)
    19. 19. Low intensity interventions  Brief individual CBT (including ERP) using structured self help  Brief individual CBT (including ERP) by telephone  Group CBT (including ERP)
    20. 20. Exposure and response prevention   Exposure is the therapeutic confrontation to a feared stimulus in imagination or in vivo until fear subsides (process known as habituation). Response prevention is resisting carrying out the ritual.
    21. 21. Small group work   In small groups discuss for 10 minutes the advantages and disadvantages of group treatment for people with OCD Identify a scribe to feedback to the large group
    22. 22. Advantages of group treatment    Cost effective ‘sharing’ of experiences between participants Possibly more motivating for participants
    23. 23. Disadvantages of group treatment    Some people don’t like group treatment Difficult to organise at a convenient time for all group members It may be more difficult to involve families/relatives
    24. 24. Group CBT – The evidence base  Cordioli et al (2003) RCT: compared efficacy of group CBT with waiting list control  McLean et al (2001) RCT: compared efficacy of two group treatment types (CBT or ERP) by two time frames (immediate or delayed start)  Jones & Menzies (1998) RCT compared efficacy of DIRT with a waiting list control  Fals-Stewart et al (1993) RCT compared effectiveness of group behaviour therapy with individual behaviour therapy  Emmelkamp et al (1988) RCT compared group cognitive therapy (RET) with group behaviour therapy (exposure in vivo)
    25. 25. Systematic review  Reviewed 13 trials of group CBT treatment. Overall pre–post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT.  Jónsson & Hougaard Group cognitive behavioural therapy for obsessive– compulsive disorder: a systematic review and meta-analysis (2009). Acta Psychiatrica Scandinavica, Volume 119, Pages: 98-106
    26. 26. What does this evidence mean     Post treatment, group CBT was found to be more effective than either no therapy or sertraline, but no different than ERP There are no RCTs in adults with OCD comparing the effectiveness of group CBT with individual CBT. Group CBT for OCD is effective Further research is needed to evaluate individual versus group CBT for OCD.
    27. 27. Group CBT - Application  Pre attendance  Detailed individual assessment of problem  Explanation of group process, expectations and treatment model to enable the individual to make an informed decision  Willingness and commitment to participate in group CBT
    28. 28. Group CBT - Application        Closed group format 5 – 12 participants 1 or 2 therapists Weekly or twice weekly sessions 1 – 2.5 hours duration 7 -12 sessions plus follow up Pre, post and follow-up measures
    29. 29. Group CBT - Application       Education regarding OCD and treatment model CBT including ERP Relapse prevention Between session tasks tasks Monitoring progress Telephone contact between sessions if required
    30. 30. Any questions
    31. 31. Evaluation     Was the workshop at the right level Did it cover what you wanted What did you like What would you want to change if we were to do the workshop again
    32. 32. Thank you for listening Karina.Lovell@manchester.ac.uk

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