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Mindfulness-Based Cognitive Therapy for OCD: Stand-Alone and Post-CBT Augmentation Approaches

  • Advancements in Cognitive-Behavioral Modeling and Treatment of OCD
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Abstract

Mindfulness, defined as the awareness that emerges through paying attention on purpose, in the present moment and nonjudgmentally, promotes engagement with internal experience and has been shown to reduce symptoms of anxiety and depression in meta-analyses, but few have tested its potential benefits in Obsessive Compulsive Disorder (OCD). The following study aimed to test the preliminary efficacy of an OCD-tailored 8-week course of Mindfulness Based Cognitive Therapy (MBCT) to treatment-seeking patients with OCD. Treatment-seeking participants (N = 37) with a principal DSM-5 (APA 2013) diagnosis of OCD completed an 8-week MBCT group intervention (adapted from Segal et al. 2013) tailored to OCD either prior to receiving CBT (n = 19) or following a 14-week CBT intervention (n = 18). Participants completed measures of obsessive–compulsive symptoms (including the Y-BOCS), depression (BDI-II), mindfulness (FFMQ), and Obsessive Beliefs Questonnaire (OBQ) at baseline and post-treatment. Repeated measures analysis of variance demonstrated significant change from pre- to post-treatment in both MBCT treatment groups, with no condition or condition by time effects. These preliminary results demonstrate the potential efficacy of MBCT for OCD with large and significant reductions in obsessive–compulsive symptoms from pre- to post-treatment both as a stand-alone treatment, prior to other first-line interventions and as an augmentation treatment for patients showing only partial response to CBT.

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Notes

  1. Of 37 participants, the following demographic information was missing: education (n = 3), ethnicity (n = 1), marital status (n = 1), and occupation (n = 1)

References

  • Abramowitz, J. S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology, 65(1), 44–52.

    Article  PubMed  Google Scholar 

  • Aderka, I. M., Anholt, G. E., van Balkom, A. J. L. M., Smit, J. H., Hermesh, H., Hofmann, S. G., & van Oppen, P. (2011). Differences between early and late drop-outs from treatment for obsessive-compulsive disorder. Journal of Anxiety Disorders, 25, 918–923.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Anderson, N. D., Lau, M. A., Segal, Z. V., & Bishop, S. R. (2007). Mindfulness-based stress reduction and attentional control. Clinical Psychology & Psychotherapy, 14(6), 449–463. https://doi.org/10.1002/cpp.544.

    Article  Google Scholar 

  • Baer, L., Brown-Beasley, M. W., Sorce, J., & Henriques, A. I. (1993). Computer-assisted telephone administration of a structured interview for obsessive–compulsive disorder. American Journal of Psychiatry, 150, 1737–1738.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45. https://doi.org/10.1177/1073191105283504.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342. https://doi.org/10.1177/1073191107313003.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. (1996). Manual for Beck Depression Inventory—II. San Antonio: Pearson Assessment.

    Google Scholar 

  • Bogels, S. M., Sijbers, G. F. V. M., & Voncken, M. (2006). Mindfulness and task concentration training for social phobia: a pilot study. Journal of Cognitive Psychotherapy: An International Quarterly, 20(1), 33–44. https://doi.org/10.1891/jcop.20.1.33.

    Article  Google Scholar 

  • Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15, 593–600.

    Article  PubMed  Google Scholar 

  • Clark, D. A. (2004). Cognitive behavioural therapy for OCD. New York: Guilford.

    Google Scholar 

  • Clark, D. A., & Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist, 28, 161–167.

    Article  Google Scholar 

  • Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: a preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36, 553–568.

    Article  Google Scholar 

  • Crane, R. (2009). Mindfulness-based cognitive therapy: distinctive features. London: Routledge.

    Google Scholar 

  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behavior Ressearch and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006.

    Article  Google Scholar 

  • Dozois, D. J. A., & Covin, R. (2004). The Beck Depression Inventory—II (BDI-II), Beck Hopelessness Scale (BHS), and Beck Scale for Suicide Ideation (BSS). In M. Hersen (Series Ed.), D. L. Segal, & M. Hilsenroth (Vol Eds.), Comprehensive handbook of psychological assessment: volume 2. Personality assessment and psychopathology (pp. 50–69). Hoboken, NJ: Wiley.

  • Eddy, K. T., Dutra, L., Bradley, R., & Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24(8), 1011–1030. https://doi.org/10.1016/j.cpr.2004.08.004.

    Article  PubMed  Google Scholar 

  • Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716–721.

    Article  PubMed  Google Scholar 

  • Fairfax, H. (2008). The use of mindfulness in obsessive compulsive disorder: suggestions for its application and integration in existing treatment. Clinical Psychology & Psychotherapy, 15, 53–59.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute.

    Google Scholar 

  • Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., Simpson, H. B., & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. The American Journal of Psychiatry, 162, 151–161.

    Article  PubMed  Google Scholar 

  • Frost, R. O., & Steketee, G. (2002). Cognitive approaches to obsessions and compulsions: theory, assessment and treatment. Oxford: Pergamon.

    Google Scholar 

  • Grove, W., Andreasen, N., McDonald-Scott, P., Keller, M., & Shapiro, R. (1981). Reliability studies of psychiatric diagnosis. Archives of General Psychiatry, 38, 408–413. https://doi.org/10.1001/archpsyc.1981.01780290042004.

    Article  PubMed  Google Scholar 

  • Hanstede, M., Gidron, Y., & Nyklícek, I. (2008). The effects of a mindfulness intervention on obsessive-compulsive symptoms in a non-clinical student population. The Journal of Nervous and Mental Disease, 196, 776–779.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183. https://doi.org/10.1037/a0018555.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jakes, I. (1989a). Salkovskis on obsessional-compulsive neurosis: a critique. Behaviour Research and Therapy, 27(6), 673–675. https://doi.org/10.1016/0005-7967(89)90151-4.

    Article  PubMed  Google Scholar 

  • Jakes, I. (1989b). Salkovskis on obsessional-compulsive neurosis: a rejoinder. Behaviour Research and Therapy, 27(6), 683–684. https://doi.org/10.1016/0005-7967(89)90153-8.

    Article  Google Scholar 

  • Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective, & Behavioral Neuroscience, 7(2), 109–119.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion.

    Google Scholar 

  • Kabat-Zinn, J., Massion, A. O., Kristeller, J., & Peterson, L. G. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943.

    Article  PubMed  Google Scholar 

  • Key, B. L., Rowa, K., Bieling, P., McCabe, R., & Pawluk, E. J. (2017). Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder. Clinical Psychology & Psychotherapy, 24, 1109–1120.

    Article  Google Scholar 

  • Kim, Y. W., Lee, S. H., Choi, T. K., Suh, S. Y., Kim, B., Kim, C. M., et al. (2009). Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depression and Anxiety, 26, 601–606.

    Article  PubMed  Google Scholar 

  • Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behaviour Research and Therapy, 45(10), 2518–2526. https://doi.org/10.1016/j.brat.2007.04.011.

    Article  PubMed  Google Scholar 

  • Kozak, M. J., Liebowitz, M. R., & Foa, E. B. (2000). Cognitive behavior therapy and pharmacotherapy for obsessive-compulsive disorder: the NIMH-sponsored collaborative study. In W. K. Goodman, M. V. Rudorfer, & J. D. Maser (Eds.), Obsessive-compulsive disorder: contemporary issues in treatment (pp. 501–530, Chapter xxii, 661 pages). Mahwah: Lawrence Erlbaum Associates Publishers.

    Google Scholar 

  • Lee, S. H., Ahn, S. C., Lee, Y. J., Choi, T. K., Yook, K. H., & Suh, S. Y. (2007). Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research, 62, 189–195.

    Article  PubMed  Google Scholar 

  • National Institute for Clinical Excellence. (2007). Depression: management of depression in primary and secondary care. Clinical Guideline 23 (amended). London: NICE.

    Google Scholar 

  • Obsessive Compulsive Cognitions Working Group (OCCWG). (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006.

    Article  Google Scholar 

  • Obsessive Compulsive Cognitions Working Group (OCCWG). (2003). Psychometric validation of the obsessive belief questionnaire and the interpretation of intrusions inventory: part I. Behaviour Research and Therapy, 41, 863–878.

    Article  Google Scholar 

  • Obsessive Compulsive Cognitions Working Group (OCCWG). (2005). Psychometric validation of the obsessive belief questionnaire and the interpretation of intrusions inventory: part 2. Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.

    Article  Google Scholar 

  • Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2012). Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 33–41.

    Article  PubMed  Google Scholar 

  • Ost, L., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169.

    Article  PubMed  Google Scholar 

  • Patel, S. R., Carmody, J., & Simpson, H. B. (2007). Adapting mindfulness-based stress reduction for treatment of obsessive compulsive disorder: a case report. Cognitive and Behavioural Practice, 14, 375–380.

    Article  Google Scholar 

  • Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 31, 1032–1040.

    Article  PubMed  Google Scholar 

  • Ponniah, K., Magiati, I., & Hollon, S. D. (2013). An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults. J Obsessive Compuls Relat Disord, 2(2), 207–218.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.

    Article  PubMed  Google Scholar 

  • Rosa-Alcázar, A., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008). Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review, 28(8), 1310–1325. https://doi.org/10.1016/j.cpr.2008.07.001.

    Article  PubMed  Google Scholar 

  • Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682.

    Article  PubMed  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (Second ed.). New York: The Guilford Press.

    Google Scholar 

  • Siegel, D. J. (2010). Mindsight: the new science of personal transformation. New York: Bantam.

    Google Scholar 

  • Simpson, H. B., Franklin, M. E., Cheng, J., Foa, E. B., & Liebowitz, M. R. (2005). Standard criteria for relapse are needed in obsessive-compulsive disorder. Depression and Anxiety, 21(1), 1–8. https://doi.org/10.1002/da.20052.

    Article  PubMed  Google Scholar 

  • Singh, N. N., Wahler, R. G., Winton, A. S., & Adkins, A. D. (2004). A mindfulness-based treatment of obsessive-compulsive disorder. Clinical Case Studies, 3, 275–287.

    Article  Google Scholar 

  • Squazzin, C. M. G., Key, B. L., Rowa, K., Bieling, P. J., & McCabe, R. E. (2017). Mindfulness-based cognitive therapy for residual symptoms in obsessive-compulsive disorder: a qualitative analysis. Mindfulness, 8, 190–203.

    Article  Google Scholar 

  • Steketee, G., Frost, R., & Bogart, K. (1996). The Yale-Brown Obsessive Compulsive Scale: interview versus self-report. Behaviour Research and Therapy, 34(8), 675–684.

    Article  PubMed  Google Scholar 

  • Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287. https://doi.org/10.1037//0022-006X.70.2.275.

    Article  PubMed  Google Scholar 

  • Wilkinson-Tough, M., Bocci, L., Thorne, K., & Herlihy, J. (2010). Is mindfulness-based therapy an effective intervention for obsessive-intrusive thoughts: a case series. Clinical Psychology & Psychotherapy, 17, 250–268.

    Google Scholar 

  • Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: freeing yourself from chronic unhappiness. New York: Guilford Press.

    Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Danielle Katz for her editorial assistance.

Funding

This research was supported by internal funds from the Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre.

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Correspondence to Neil A. Rector.

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All aspects of the clinical protocol were approved by the Sunnybrook Health Sciences Centre (SHSC) Research Ethics Board.

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Selchen, S., Hawley, L.L., Regev, R. et al. Mindfulness-Based Cognitive Therapy for OCD: Stand-Alone and Post-CBT Augmentation Approaches. J Cogn Ther 11, 58–79 (2018). https://doi.org/10.1007/s41811-018-0003-3

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