Effects and side effects of a transdiagnostic bias modification intervention in a mixed sample with obsessive–compulsive and/or depressive symptoms—a randomized controlled trial
Obsessive–compulsive disorder (OCD) and major depression disorder (MDD) are underdiagnosed and undertreated mental disorders. Prior studies have verified the efficacy of the self-help manual My Metacognitive Training (myMCT) for patients with primary OCD. As depression and OCD share a number of (meta)cognitive biases and dysfunctional coping strategies, we examined the efficacy of myMCT in a mixed patient sample with OCD and/or depression. A total of 80 Italian-speaking individuals with symptoms of OCD and/or depression were randomized to either myMCT or to a waitlist control group (both groups had access to care as usual during the intervention). Post-assessment was carried out 6 weeks after inclusion. Scores on the Beck Depression Inventory-II scale (BDI-II) served as the primary outcome. Adverse effects were assessed with a newly devised self-report scale. Participants in the myMCT condition showed significant symptom improvement on the BDI-II scale at a medium to large effect size compared to the control group (using intention-to-treat and per protocol analyses). The intention-to-treat analyses yielded significant positive effects on the PHQ-9 scores and psychological as well as environmental well-being in favor of myMCT; for the OCI-R total score, group differences bordered significance in favor of the myMCT. The most prevalent adverse effects were feeling pressured by the suggested exercises or feeling bad due to not performing the exercises correctly. Our results indicate that the myMCT manual represents an effective program for patients with OCD as well as those with depressive symptoms in an Italian-speaking population. Adverse events due to unguided self-help deserve more attention in the future.
KeywordsObsessive–compulsive disorder Depression Metacognitive training Self-help Bibliotherapy
The authors wish to thank Kathy McKay for copyediting the manuscript.
The study was financed by internal funds.
- 14.Dèttore D, Pozza A, Andersson G (2015) Efficacy of technology-delivered cognitive behavioural therapy for OCD versus control conditions, and in comparison with therapist-administered CBT: meta-analysis of randomized controlled trials. Cogn Behav Ther 44:190–211PubMedCrossRefPubMedCentralGoogle Scholar
- 17.Tolin DF, Hannan S, Maltby N, Diefenbach GJ, Worhunsky P, Brady RE (2007) A randomized controlled trial of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive–compulsive disorder patients with prior medication trials. Behav Ther 38:179–191PubMedCrossRefPubMedCentralGoogle Scholar
- 23.Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A et al (2017) Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms a meta-analysis of individual participant data. JAMA Psychiatry 74:351–359PubMedCrossRefPubMedCentralGoogle Scholar
- 27.Hayes SC, Masuda A, DeMey H (2003) Acceptance and commitment therapy and the third wave of behavior therapy. Dutch J Behav Ther 2:69–96Google Scholar
- 30.Moritz S, Jelinek L (2007) Association splitting—self-help guide for reducing obsessive thoughts. VanHam Campus Verlag, HamburgGoogle Scholar
- 56.Motivala SJ, Arellano M, Greco RL, Aitken D, Hutcheson N, Tadayonnejad R et al (2018) Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy. Int J Psychiatry Clin Pract 22:40–46PubMedCrossRefPubMedCentralGoogle Scholar
- 57.Moritz S, Fieker M, Hottenrott B, Seeralan T, Cludius B, Kolbeck K et al (2015) No pain, no gain? Adverse effects of psychotherapy in obsessive–compulsive disorder and its relationship to treatment gains. J Obsessive Compuls Relat Disord 5:1. https://doi.org/10.1016/j.jocrd.2015.02.002 CrossRefGoogle Scholar
- 58.Beck AT, Steer RA, Brown GK (1996) Beck depression inventory, 2nd edn. The Psychological Corporation, San AntonioGoogle Scholar
- 59.Sica C, Ghisi M (2007) The Italian versions of the Beck Anxiety Inventory and the Beck Depression Inventory-II: psychometric properties and discriminant power. In: Lang MA (ed) Leading-edge psychological tests and testing research. Nova Science Publishers, Hauppauge, pp 27–50Google Scholar
- 76.Schmidt J, Wittman WW (2008) Fragebogen zur Messung der Patientenzufriedenheit—ZUF-8. Diagn Verfahren Rehabil 255:248–255Google Scholar
- 77.Schmidt J, Nübling R, Lamprecht F, Wittmann W (1994) Patientenzufriedenheit am Ende psychosomatischer Rehabehandlungen. Zusammenhänge mit Behandlungs- und Ergebnisvariablen und prognostische Bedeutung. In: Lamprecht F, Johnen R (eds) Salutogenese. Ein neues Konzept in der Psychosomatik? VAS-Verlag: Frankfurt am Main, pp 271–28.Google Scholar
- 78.Kriz D, Nübling R, Steffanowski A, Rieger J, Schmidt J (2008) Patientenzufriedenheit: psychometrische reanalyse des ZUF-8. Deutsche Rentenversicherung Bund, BerlinGoogle Scholar
- 81.Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford Press, New YorkGoogle Scholar
- 85.Moritz S, Stepulovs O, Schröder J, Hottenrott B, Meyer B, Hauschildt M (2016) Is the whole less than the sum of its parts? Full versus individually adapted metacognitive self-help for obsessive–compulsive disorder: a randomized controlled trial. J Obsessive Compuls Relat Disord 9:107–115CrossRefGoogle Scholar