Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-27T06:55:04.621Z Has data issue: false hasContentIssue false
  • English
  • Français

A brief course of digitally delivered cognitive behavioural therapy for the treatment of blood contamination-based obsessive-compulsive disorder: a structured case report

Published online by Cambridge University Press:  28 July 2022

Jack Purrington Open the ORCID record for Jack Purrington [Opens in a new window]
Jack Purrington*
Affiliation:
Clinical Psychology Unit, University of Sheffield, Sheffield, UK
*
Email: jpurrington1@sheffield.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

The lifetime prevalence of OCD in the UK is estimated to be between 1 in 100 and 1 in every 50 people. It is therefore necessary to explore innovations in practice to expand the reach of the gold standard therapeutic approaches of exposure with response prevention (ERP) and cognitive behavioural therapy (CBT). The COVID-19 pandemic has facilitated such innovations with several services accommodating changes to routine practice by utilising digital platforms to provide videoconference-delivered therapy. Despite a growing evidence base demonstrating efficacy and scope for the use of videoconference-delivered CBT for obsessive-compulsive disorder (OCD), there remains qualitative research collated from clinicians which suggests that a lack of practitioner confidence and a low belief in positive outcomes are barriers to adopting remote therapy practices for clinicians. Therefore, this structured case report describes the assessment, formulation, intervention and outcome of an 11-week videoconference-delivered therapeutic intervention. Reflections are made regarding the use of the digital platform throughout the intervention, alongside the strengths and difficulties of applying videoconference-delivered CBT for OCD.

Key learning aims

  1. (1) To illustrate a digital treatment of OCD through flexible application of the current evidence base.

  2. (2) To gain an understanding of the strengths and weaknesses of delivering digital out-patient CBT for OCD.

  3. (3) To consider the utility of structured case reports in routine practice when delivering digital therapy.

Keywords

case studyCBTdigital therapyERPOCDremote therapy
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e35
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Matsumoto, K., Sutoh, C., Asano, K., Seki, Y., Urao, Y., Yokoo, M., Takanashi, R., Yoshida, T., Tanaka, M., Noguchi, R., Nagata, S., Oshiro, K., Numata, N., Hirose, M., Yoshimura, K., Nagai, K., Sato, Y., Kishimoto, T., Nakagawa, A., & Shimizu, E. (2018). Internet based cognitive behavioural therapy with real-time therapist support via videoconference for patients with obsessive-compulsive disorder, panic disorder, and social anxiety disorder: pilot single-arm trial. Journal of Medical Internet Research, 20, e:12091. https://doi.org/10.2196/12091 CrossRefGoogle ScholarPubMed
Vogel, P. A., Solem, S., Hagen, K., Moen, E. M., Launes, G., Haland, A. T., Hansen, B., Himle, J. A. (2014). A pilot randomized controlled trial of videoconference-assisted treatment for obsessive-compulsive disorder. Behaviour Research and Therapy, 63, 162–168. https://doi.org/10.1016/j.brat.2014.10.007 CrossRefGoogle ScholarPubMed

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2013). Exposure Therapy for Anxiety: Principles and Practice. New York, USA: Guildford Press.Google Scholar
Andersson, E., Enander, J., Andren, P., & Hed, E. (2012). Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomised controlled trial. Psychological Medicine, 42(10), 2193–2203. https://doi.org/10.1017/s0033291712000244 CrossRefGoogle Scholar
Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., Falloon, K., & Hatcher, S. (2010). Validation of the PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine, 8, 348–353. https://doi.org/10.1370/afm.1139 CrossRefGoogle ScholarPubMed
Aspvall, K., Andersson, E., Melin, K., Norlin, L., Eriksson, V., Vigerland, S., Jolstedt, M., Silverberg-Morse, M., Wallin, L., Sampaio, F., Feldman, I., Bottai, M., Lenhard, F., Mataix-Cols, D., & Serlachius, E. (2021). Effect of an internet-delivered stepped-care program vs in-person cognitive behavioural therapy on obsessive-compulsive disorder symptoms in children and adolescents. JAMA, 325, 1863–1873. https://doi.org/10.1001/jama.2021.3839 CrossRefGoogle ScholarPubMed
Beck, A. T. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004 CrossRefGoogle ScholarPubMed
Beck, A. T., Brown, G. K., & Steer, R. A. (1996). Manual for the Beck Depression Inventory – Second Edition (BDI-II). Psychological Corporation.Google Scholar
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review. Journal of Anxiety Disorders, 28, 612–624. https://doi.org/10.1016/j.janxdis.2014.06.008 CrossRefGoogle ScholarPubMed
Brakoulias, V., Starcevic, V., Belloch, A., Brown, C., Ferrao, A., Fontenelle, L. F., Lochner, C., Marazziti, D., Matsunagai, H., Miguel, E. C., Reddy, C. J., do Rossario, M. C., Shavitti, R. G., Shyam-Sundar, A., Stein, D. J., Torres, A. R., & Viswasam, K. (2017). Comorbidity, age of onset and suicidality in obsessive-compulsive disorder (OCD): an international collaboration. Comprehensive Psychiatry, 76, 79–86. https://doi.org/10.1016/j.comppsych.2017.04.002 CrossRefGoogle Scholar
Campbell, D. T., Cook, T. D., & Shadish, W. R. (2001). Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Boston, MA: Houghton Mifflin.Google Scholar
Challacombe, F., Oldfield, V. B., & Salkovskis, P. (2011). Break Free From OCD: Overcoming Obsessive Compulsive Disorder with CBT. Vermillon.Google Scholar
Derogatis, L. R. (1983). SCL-90-R: Administration, Scoring & Procedures: Manual. Clinical Psychometric Research.Google Scholar
Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: an introductory report. Psychological Medicine, 13, 595–605. https://doi.org/10.1017/s0033291700048017 CrossRefGoogle Scholar
Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE-OM. British Journal of Psychiatry, 180, 51–60. https://doi.org/10.1192/bjp.180.1.51 CrossRefGoogle ScholarPubMed
Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin, K., Connell, J., & McGrath, G. (2000). CORE: Clinical outcomes in routine evaluation. Journal of Mental Health, 9, 247–255. https://doi.org/10.1080/713680250 CrossRefGoogle Scholar
Faija, C. L., Connell, J., Welsh, C., Ardern, K., Hopkin, E., Gellatly, J., Rushton, K., Irvine, A., Armitage, C. J., Wilson, P., Bower, P., Lovell, K., & Bee, P. (2020). What influences practitioners’ readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the theoretical domains framework. BMC Psychiatry, 20, 1–16. https://doi.org/10.1186/s12888-020-02761-3 CrossRefGoogle ScholarPubMed
Ferentinos, P., Preti, A., Veroniki, A. A., Pitsalidis, K. G., Theofilidis, A. T., Antoniou, A., & Fountoulakis, K. N. (2020). Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: systematic review and meta-analysis of its prevalence. Journal of Affective Disorders, 263, 193–208. https://doi.org/10.1016/j.jad.2019.11.136 CrossRefGoogle ScholarPubMed
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M., & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: the Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206–214. https://doi.org/10.1037/1040-3590.10.3.206 CrossRefGoogle Scholar
Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the general health questionnaire. Psychological Medicine, 9, 139–145. https://doi.org/10.1017/s0033291700021644 CrossRefGoogle ScholarPubMed
Grant, J. E., Drummond, L., Nicholson, T. R., Fagan, H., Baldwin, D. S., Fineberg, N. A., & Chamberlain, S. R. (2022). Obsessive-compulsive symptoms and the Covid-19 pandemic: a rapid scoping review. Neuroscience & Biobehavioural Reviews, 132, 1084–1098. https://doi.org/10.1016/j.neubiorev.2021.10.039 CrossRefGoogle ScholarPubMed
Guzick, A. G., Candelari, A., Wiese, A. D., Schneider, S. C., Goodman, W. K., & Storch, E. A. (2021). Obsessive-compulsive disorder during the COVID-19 pandemic: a systematic review. Current Psychiatry Reports: Topical Collection on Anxiety Disorders, 23, 1–10. https://doi.org/10.1007/s11920-021-01284-2 CrossRefGoogle ScholarPubMed
Herbst, N., Voderholzer, U., Thiel, N., Schaub, R., Kaevelsrud, C., Stracke, S., Hertenstein, E., Nissen, C., Kulz, A. K. (2014). No talking, just writing! Efficacy of an internet-based cognitive behavioural therapy with exposure and response prevention in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 83, 165–175. https://doi.org/10.1159/000357570 CrossRefGoogle ScholarPubMed
Hodgson, R. J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy, 15, 389–395. https://doi.org/10.1016/0005-7967(77)90042-0 CrossRefGoogle ScholarPubMed
Jacobson, N. S., Follette, W. C., & Revenstorf, D. (1984). Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behaviour Therapy, 15, 336–352. https://doi.org/10.1016/s0005-7894(84)80002-7 CrossRefGoogle Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychologist, 59, 12–19. https://doi.org/10.1037/0022-006x.59.1.12 CrossRefGoogle ScholarPubMed
Jassi, A., Shahrivarmolki, K., Taylor, T., Peile, L., Challacombe, F., Clark, B., & Veale, D. (2020). OCD and COVID-19: A new frontier. the Cognitive Behaviour Therapist, 31, 1–11. https://doi.org/10.1017/s1754470x20000318 Google Scholar
Jones, R. R., Weinrott, M. R., & Vaught, R. S. (1978). Effects of serial dependency on the agreement between visual and statistical inference. Journal of Applied Behaviour Analysis, 11, 277–283. https://doi.org/10.1901/jaba.1978.11-277 CrossRefGoogle ScholarPubMed
Kendall, M. G. (1938). A new measure of rank correlation. Biometrika, 30, 81–93. https://doi.org/10.1093/biomet/30.1-2.81 CrossRefGoogle Scholar
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9 validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Kulz, A. K., Landmann, S., Schmidt-Ott, M., Zurowski, B., Wahl-Kordon, A., & Vorderholzer, U. (2020). Long-term follow-up of cognitive-behavioural therapy for obsessive-compulsive disorder: symptoms severity and the role of exposure 8–10 years after inpatient treatment. Journal of Cognitive Psychotherapy, 34(3), 261–271. https://doi.org/10.1891/jcpsy-d-20-00002 CrossRefGoogle ScholarPubMed
Kyrios, M., Ahern, C., Fassnacht, D. B., Nedeljkovic, M., Moudling, R., & Meyer, D. (2018). Therapist-assisted internet-based cognitive behavioural therapy versus progressive relaxation in obsessive-compulsive disorder: randomized control trial. Journal of Medical Internet Research, 20, e242. https://doi.org/10.2196/jmir.9566 CrossRefGoogle Scholar
Lamb, T., Pachana, N. A., & Dissanavaka, N. (2019). Update of recent literature on remotely delivered psychotherapy interventions for anxiety and depression. Telemedicine and E-Health, 25, 671–677. https://doi.org/10.1089/tmj.2018.0079 CrossRefGoogle ScholarPubMed
Lenz, S. A. (2013). Calculating effect size in single-case research: a comparison of nonoverlap methods. Measurement and Evaluation in Counseling and Development, 46, 64–73. https://doi.org/10.1177/0748175612456401 CrossRefGoogle Scholar
Li, I., Millard, M., Haskelberg, H., Hobbs, M., Luu, J., & Mahoney, A. (2022). COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy, 50, 219–236. https://doi.org/10.1017/s1352465821000448 CrossRefGoogle ScholarPubMed
Ljung, G. M., & Box, G. E. P. (1978). On a measure of lack of fit in time series models. Biometrika, 65, 297–303. https://doi.org/10.1093/biomet/65.2.297 CrossRefGoogle Scholar
Ma, H. H. (2006). An alternative method for quantitative synthesis of single-subject researches. Behaviour Modification, 30, 598–617. https://doi.org/10.1177/0145445504272974 CrossRefGoogle ScholarPubMed
Marks, I. M., Hallam, R. S., Connolly, J., & Philpott, R. (1977). Nursing in Behavioural Psychotherapy. Royal College of Nursing. Google Scholar
Matsumoto, K., Sutoh, C., Asano, K., Seki, Y., Urao, Y., Yokoo, M., Takanashi, R., Yoshida, T., Tanaka, M., Noguchi, R., Nagata, S., Oshiro, K., Numata, N., Hirose, M., Yoshimura, K., Nagai, K., Sato, Y., Kishimoto, T., Nakagawa, A., & Shimizu, E. (2018). Internet based cognitive behavioural therapy with real-time therapist support via videoconference for patients with obsessive-compulsive disorder, panic disorder, and social anxiety disorder: pilot single-arm trial. Journal of Medical Internet Research, 20, e:12091. https://doi.org/10.2196/12091 CrossRefGoogle ScholarPubMed
McDowall, D., McCleary, R., & Bartos, B. J. (2019). Interrupted Time Series Analysis. Oxford: Oxford University Press.CrossRefGoogle Scholar
McKay, D. (2008). The treatment of obsessions: reviewed by Dean McKay. The Primary Care Companion to The Journal of Clinical Psychiatry, 10, 169. https://doi.org/10.4088/pcc.v10n0214a CrossRefGoogle Scholar
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M. Matthews, K., & Veale, D. (2015). Efficacy of cognitive-behavioural therapy for obsessive-compulsive disorder. Psychiatry Research, 225, 236–246. https://doi.org/10.1016/j.psychres.2014.11.058 CrossRefGoogle ScholarPubMed
McMillan, D., & Morley, S. (2010). The quantitative single-case design as a research strategy for practice-based evidence. In Barkham, M., Hardy, G. E. & Mellor-Clark, J. (eds), Developing and Delivering Practice-Based Evidence: A Guide for the Psychological Therapies (pp. 109–138). UK: Wiley. https://doi.org/10.1002/9780470687994 CrossRefGoogle Scholar
Murphy, R., & Bryan, A. (1980). Multiple-baseline and multiple-probe designs: practical alternatives for special education assessment and evaluation. Journal of Special Education, 14, 325–335. https://doi.org/10.1177/002246698001400306 CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2005). Clinical Guideline CG31. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Retrieved from https://www.nice.org.uk/guidance/cg31 (accessed 10 November 2020).Google Scholar
NHS England (2019). The Improving Access to Psychological Therapies manual: appendices and helpful resources. Retrieved from: https://www.england.nhs.uk/wp-content/uploads/2019/12/iapt-manual-helpful-resources-v2.pdf (accessed 15 November 2020).Google Scholar
Overbeek, T., Schruers, K., Vermetten, E., & Griez, E. (2002). Comorbidity of obsessive-compulsive disorder and depression. Journal of Clinical Psychiatry, 63, 1106–1112. https://doi.org/10.4088/jcp.v63n1204 CrossRefGoogle ScholarPubMed
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: a review of nine nonoverlap techniques. Behaviour Modification, 35, 303–322. https://doi.org/10.1177/0145445511399147 CrossRefGoogle ScholarPubMed
Patel, S. R., Wheaton, M. G., Andersson, E., Ruck, C., Schmidt, A. B., La Lima, C. N., Galfavy, H., Pascucci, O., Myers, R. W., Dixon, L. B., & Blair-Simpson, H. (2018). Acceptability, feasibility, and effectiveness of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder in New York. Behavior Therapy, 49, 631–641. https://doi.org/10.1016/j.beth.2017.09.003 CrossRefGoogle ScholarPubMed
Pavlov, I. P. (1927). Conditioned Reflexes: An Investigation of the Physiological Activity of the Cerebral Cortex. Translated and edited by Anrep, G. V.. Oxford: Oxford University Press.Google Scholar
Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive-behavioural approach to understanding obsessional thinking. British Journal of Psychiatry, 173, 53–63. https://doi.org/10.1192/s0007125000297900 CrossRefGoogle Scholar
Salkovskis, P. M., & Kirk, J. (1997). Obsessive-compulsive disorder. In Clark, D. M. & Fairburn, C. G. (eds), Science and Practice of Cognitive Behaviour Therapy (pp. 179–209). Oxford: Oxford University Press.Google Scholar
Scruggs, T. E., & Mastropieri, M. A. (1998). Summarizing single-subject research. Behaviour Modification, 22, 221–242. https://doi.org/10.1177/01454455980223001 CrossRefGoogle ScholarPubMed
Scruggs, T. E., Mastropieri, M. A., & Casto, G. (1987). The quantitative synthesis of single-subject research. Remedial and Special Education, 8, 24–33. https://doi.org/10.1177/074193258700800206 CrossRefGoogle Scholar
Smith, J. D. (2012). Single-case experimental designs: a systematic review of published research and current standards. Psychological Methods, 17, 510–550. https://doi.org/10.1037/a0029312 CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalised anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle Scholar
Tarlow, K. R. (2016). Baseline Corrected Tau Calculator. http://www.ktarlow.com/stats/tau Google Scholar
Vannest, K. J., & Ninci, J. (2015). Evaluating intervention effects in single-case research designs. Journal of Counselling & Development, 93, 403–411. https://doi.org/10.1002/jcad.12038 CrossRefGoogle Scholar
Veale, D. (2007). Cognitive-behavioural therapy for obsessive-compulsive disorder. Advances in Psychiatric Treatment, 13, 438–446. https://doi.org/10.1192/apt.bp.107.003699 CrossRefGoogle Scholar
Veale, D., & Roberts, A. (2014). Clinical review: obsessive-compulsive disorder. BMJ, 348, g2183–g2183. https://doi.org/10.1136/bmj.g2183 CrossRefGoogle Scholar
Visser, H. A., van Megen, H., van Oppen, P., Eikelenboom, M., Hoogendorn, A. W., Kaarsemaker, M., & van Balkom, A. J. (2015). Inference-based approach versus cognitive behavioural therapy in the treatment of obsessive-compulsive disorder with poor insight: a 24-session randomised controlled trial. Psychotherapy and Psychosomatics, 84, 284–293. https://doi.org/10.1159/000382131 CrossRefGoogle Scholar
Vogel, P. A., Launes, G., Moen, E. M., Solem, S., Hansen, B., Haaland, A. T., & Himle, J. A. (2012). Videoconference- and cell phone- based cognitive-behavioural therapy of obsessive-compulsive disorder: a case series. Journal of Anxiety Disorders, 26, 158–164. https://doi.org/10.1016/j.janxdis.2011.10.009 CrossRefGoogle ScholarPubMed
Vogel, P. A., Solem, S., Hagen, K., Moen, E. M., Launes, G., Haland, A. T., Hansen, B., Himle, J. A. (2014). A pilot randomized controlled trial of videoconference-assisted treatment for obsessive-compulsive disorder. Behaviour Research and Therapy, 63, 162–168. https://doi.org/10.1016/j.brat.2014.10.007 CrossRefGoogle ScholarPubMed
Wheaton, M. G., Ward, H. E., Silber, A., McIngvale, E., & Bjorgvinsson, T. (2021). How is the COVID-19 pandemic affecting individuals with obsessive-compulsive disorder (OCD) symptoms? Journal of Anxiety Disorders, 81, 102410. https://doi.org/10.1016/j.janxdis.2021.102410 CrossRefGoogle Scholar
Wolpe, J. (1961). The systematic desensitisation treatment of neurosis. Journal of Nervous and Mental Disease, 132, 189–203. https://doi.org/10.1097/00005053-196103000-00001 CrossRefGoogle Scholar
Wootton, B. M. (2016). Remote cognitive-behavior therapy for obsessive–compulsive symptoms: a meta-analysis. Clinical Psychology Review, 43, 103–113. https://doi.org/10.1016/j.cpr.2015.10.001 CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.