Source Credit: ScienceDaily – Exposure/Ritual Prevention Therapy Boosts Antidepressant Treatment of OCD
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
Sep. 12, 2013 — NIMH grantees have demonstrated that a form of behavioral therapy can augment antidepressant treatment of obsessive compulsive disorder (OCD) better than an antipsychotic. The researchers recommend that this specific form of cognitive behavior therapy (CBT) — exposure and ritual prevention — be offered to OCD patients who don’t respond adequately to treatment with an antidepressant alone, which is often the case. Current guidelines favor augmentation with antipsychotics.
(EDIT- FROM JOURNAL ARTICLE- description of CBT intervention:
EX/RP Augmentation
Patients randomized to EX/RP received 17 twice-weekly 90- minute sessions delivered over 8 weeks by
a study therapist. Treatment included 2 introductory sessions, 15 exposure sessions (during which
patients faced their obsessional fears for a prolonged period without ritualizing), daily homework
(at least 1 hour of self-directed exposures daily), and between- session telephone check-ins.16 At least 2 sessions occurred outside the clinic to promote generalization to daily life. The goal was for patients to stop their rituals as early in treatment as possible; patients were asked to try refraining from ritualizing after the first exposure session. Formal cognitive therapy procedures were not used, but dysfunctional cognitions were discussed within the context of exposure.)
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In the controlled trial with 100 antidepressant-refractory OCD patients, 80 percent of those who received CBT responded, compared to 23 percent of those who received the antipsychotic risperidone, and 15 percent of those who received placebo pills. Forty-three percent experienced symptoms reduced to a minimal level following CBT treatment, compared to 13 percent for risperidone and 5 percent for placebo.
The study, published September 11, 2013 in JAMA Psychiatry, was led by Helen Blair Simpson, M.D., of Columbia University, in New York City; and Edna Foa, Ph.D., of the University of Pennsylvania, Philadelphia.
In an accompanying editorial, grantees Kerry Ressler, M.D., and Barbara Rothbaum, Ph.D., of Emory University, Atlanta, note that antidepressants are effective in treating only a subset of OCD patients. They add that the targeted form of CBT works via different mechanisms — such as retraining the brain’s habit-forming circuitry to unlearn compulsive rituals.
Matthew Rudorfer, M.D., chief of the NIMH Somatic Treatments Program, which funded the study, said that in demonstrating how different patients respond best to different approaches, it helps to move the field toward the goal of more personalized treatment.
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
Journal Reference: Helen Blair Simpson. Cognitive-Behavioral Therapy vs Risperidonefor Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive DisorderA Randomized Clinical TrialSerotonin Reuptake Inhibitor Augmentation.JAMA Psychiatry, 2013; DOI: 10.1001/jamapsychiatry.2013.1932
September 14, 2013
Posted by peterhbrown |
anxiety, brain, Cognition, Cognitive Behavior Therapy, Obsessive Compulsive Disorder, research | Barbara Rothbaum, CBT, Cognitive behavioral therapy, compulsion, Emory University, Health, Medicine, Mental health, New York City, obsessive compulsive disorder, OCD, research, response prevention, risperdone, ritual, science, ssri, University of Pennsylvania |
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Researchers from Royal Holloway, University of London have found that pregnant and postnatal women, while wanting to do the best for their baby, do not follow medical advice without question and are more likely to adopt practices their mothers and grandmothers carried out during their pregnancies.
The study by Professor Paula Nicolson and Dr Rebekah Fox from the Department of Health and Social Care at Royal Holloway is published in the Journal of Health Psychology and explores three recent generations of women’s experiences of pregnancy, questioning those who gave birth in the 1970s, 1980s and 2000s.
The women who were interviewed said they knew their mothers and grandmothers had their best interests at heart when they offered them advice. For the older women questioned, the advice from their female relations was their main source of information.
The 1980s and 2000s group, however, had to reconcile what they heard from older generations with direct advice from their doctors, midwives and health visitors as well as the numerous health messages on the web and self-help books.
Professor Nicolson says, “It is much to the credit of contemporary women that despite the unprecedented pressures from the media, medicine and the ‘pregnancy police’ that they are still able to filter-in the advice that really suits them from all these sources. Each of the three generations found ways to ‘resist’ what they considered inappropriate pressures from advisors and were more likely to follow advice given to them from their mothers and grandmothers even if it went against the medical professions advice.
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“Women tend to discuss the advice they are given with their female relatives and this leads to resistance to some types of advice. For example, despite being advised to cut down on caffeine during pregnancy one woman we questioned said she continued to drink tea because her grandmother told her it relieved her morning sickness.”
Professor Nicolson says women who take notice of general public health information about what is a healthy lifestyle, i.e not smoking, taking regular exercise, not taking drugs and drinking alcohol in moderation are those who are most likely to be in-tune with their bodies and can therefore ‘use’ guidelines but not be constrained by them.
She added: “Taking all the guidelines too seriously leads to anxieties. Lack of self-confidence also can lead to worry about ‘doing the wrong thing’ which is potentially more harmful than taking the odd glass of wine or eating soft cheese.”
Source: Sciencedaily
May 17, 2010
Posted by peterhbrown |
Education, Health Psychology, Parenting, Social Psychology | birth, doctor, Health, Medicine, Midwifery, Morning sickness, Mother, Parenting, Paula Nicolson, Pregnancy, Royal Holloway University of London, University of London |
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“Watch out, it’ll hurt for a second.” Not only children but also many adults get uneasy when they hear those words from their doctor. And, as soon as the needle touches their skin the piercing pain can be felt very clearly. “After such an experience it is enough to simply imagine a needle at the next vaccination appointment to activate our pain memory,” knows Prof. Dr. Thomas Weiss from the Friedrich-Schiller-University Jena.
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As the scientist and his team from the Dept. of Biological and Clinical Psychology could show in a study for the first time it is not only the painful memories and associations that set our pain memory on the alert. “Even verbal stimuli lead to reactions in certain areas of the brain,” claims Prof. Weiss. As soon as we hear words like “tormenting,” “gruelling” or “plaguing,” exactly those areas in the brain are being activated which process the corresponding pain. The psychologists from Jena University were able to examine this phenomenon using functional magnetic resonance tomography (fMRT). In their study they investigated how healthy subjects process words associated with experiencing pain. In order to prevent reactions based on a plain negative affect the subjects were also confronted with negatively connotated words like “terrifying,” “horrible” or “disgusting” besides the proper pain words.
“Subjects performed two tasks,” explains Maria Richter, doctoral candidate in Weiss’s team. “In a first task, subjects were supposed to imagine situations which correspond to the words,” the Jena psychologist says. In a second task, subjects were also reading the words but they were distracted by a brain-teaser. “In both cases we could observe a clear activation of the pain matrix in the brain by pain-associated words,” Maria Richter states. Other negatively connotated words, however, do not activate those regions. Neither for neutrally nor for positively connotated words comparable activity patterns could be examined.
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Can words intensify chronic pain?
“These findings show that words alone are capable of activating our pain matrix,” underlines Prof. Weiss. To save painful experiences is of biological advantage since it allows us to avoid painful situations in the future which might be dangerous for our lives. “However, our results suggest as well that verbal stimuli have a more important meaning than we have thought so far.” For the Jena psychologist the question remains open which role the verbal confrontation with pain plays for chronic pain patients. “They tend to speak a lot about their experiencing of pain to their physician or physiotherapist,” Maria Richter says. It is possible that those conversations intensify the activity of the pain matrix in the brain and therefore intensify the pain experience. This is what the Jena psychologists want to clarify in another study.
And so far it won’t do any harm not to talk too much about pain. Maybe then the next injection will be only half as painful.
Read the original research paper (PDF)
Adapted from ScienceDaily March 31 2010
April 14, 2010
Posted by peterhbrown |
Age & Ageing, anxiety, Cognition, Pain, research, Technology | back pain, chronic pain, fear, Health, Jena University, Magnetic resonance imaging, Medical Specialties, Medicine, neck pain, needle phobia, Pain, Pain Management, Physician, power of words, research, verbal, words |
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Peter H Brown Clinical Psychologist 