Introduction: Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has proven its efficacy in randomized controlled trials (RCTs). Objective: To test generalizability to routine care settings, we conducted an effectiveness study to provide naturalistic outcome data and their predictors. Methods: Pre-post changes in symptoms and impairment as well as response rates were determined in a naturalistic OCD sample (intention-to-treat, ITT, n = 393). Patients received individual CBT for OCD adopting an exposure-based, non-manualized treatment format. Linear and logistic regression analyses were applied to identify associations of sociodemographic and clinical variables with symptom change. Results: Effect size in ITT patients amounted to d = 1.47 in primary outcome (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS). Remission rates were 46.3% (ITT), 52.0% (completers), and 18.2% (non-completers). The rates of treatment response without remission, no change, and deterioration in the ITT sample were 13.2, 38, and 3%, respectively. Initial symptom severity, comorbid personality disorder, and unemployment were associated with a poorer outcome, and previous medication with a better outcome. Comorbid depressive and anxiety disorders as well as other clinical or sociodemographic variables showed no effects on symptom change. Conclusions: Outcomes in this large observational trial in a naturalistic setting correspond to available RCT findings suggesting that CBT for OCD should be strongly recommended for dissemination in routine care. Targets for further research include early prediction of non-response and development of alternative treatment strategies for patients who respond insufficiently.
Psychother Psychosom

中文翻译：

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个体认知行为疗法的有效性和成年强迫症患者预后的预测因素

简介：强迫症 (OCD) 的认知行为疗法 (CBT) 已在随机对照试验 (RCT) 中证明其疗效。目的：为了测试常规护理环境的普遍性，我们进行了一项有效性研究，以提供自然结果数据及其预测因子。方法：在自然强迫症样本（意向治疗，ITT， n = 393）中确定症状和损伤的前后变化以及反应率患者接受了针对强迫症的个体 CBT，采用基于暴露的非手动治疗形式。应用线性和逻辑回归分析来确定社会人口学和临床变量与症状变化的关联。结果：在 ITT 患者中，主要结果（Yale-Brown Obsessive-Compulsive Scale，Y-BOCS）的效应量为d = 1.47。缓解率为 46.3%（ITT）、52.0%（完成者）和 18.2%（未完成者）。ITT 样本中无缓解、无变化和恶化的治疗反应率分别为 13.2%、38% 和 3%。最初的症状严重程度、共病人格障碍和失业与较差的结果相关，而先前的药物治疗与较好的结果相关。合并抑郁症和焦虑症以及其他临床或社会人口学变量对症状变化没有影响。结论：这项在自然主义环境中进行的大型观察性试验的结果与现有的 RCT 研究结果相对应，这表明应强烈建议在常规护理中传播 CBT 治疗强迫症。进一步研究的目标包括早期预测无反应和为反应不足的患者制定替代治疗策略。
心理治疗师