Publications by authors named "Lena Jelinek"

95 Publications

Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series.

Psychiatr Q 2022 Jul 2. Epub 2022 Jul 2.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.
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http://dx.doi.org/10.1007/s11126-022-09992-5DOI Listing
July 2022

Efficacy of metacognitive training for depression as add-on intervention for patients with depression in acute intensive psychiatric inpatient care: A randomized controlled trial.

Clin Psychol Psychother 2022 Mar 11. Epub 2022 Mar 11.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Metacognitive training for depression (D-MCT) is a novel low-intensity group training for economic treatment of depression. Previous studies demonstrate its efficacy in moderately depressed outpatients. The present study evaluated efficacy and patients' perspective of the D-MCT in severely depressed psychiatric inpatients.

Methods: In a randomized-controlled trial, 75 individuals with a major depressive disorder (MDD) were allocated to D-MCT versus euthymic therapy as add-on (twice a week) to cognitive-behavioural-based (CBT) inpatient-care. Depressive symptoms (HDRS, BDI), dysfunctional (meta)cognition (DAS, MCQ-30) and subjective appraisal were assessed at baseline, 4 weeks (post) and 3 months (follow-up).

Results: Participants in both conditions showed a large decline in depression at post and follow-up-assessment. No superior add-effect of D-MCT versus active control emerged for depression severity on top of the inpatient care. However, among patients with a diagnosis of MDD with no (vs. at least one) comorbidity, D-MCT participants showed a larger decline in depressive (meta-)cognition at follow-up with medium-to-large effect sizes. D-MCT was evaluated as superior in overall appraisal, treatment preference, motivation and satisfaction.

Limitations: The follow-up time interval of 3 months may have been too short to detect long-term effects. There is emerging evidence that modification of (meta)cognition unfolds its full effects only with time. Effects of CBT inpatient-care on outcome parameters cannot be differentiated.

Conclusions: Although D-MCT as an add-on was not superior in complete case analyses, results suggest greater benefit for patients with MDD and no comorbidity. D-MCT proved feasible in acute-psychiatric inpatient-care and was highly accepted by patients. Future studies should investigate the role of modified (meta)cognition on long-term treatment outcome, including dropout and relapse rates.
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http://dx.doi.org/10.1002/cpp.2733DOI Listing
March 2022

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 pandemic: Two longitudinal studies.

Br J Clin Psychol 2022 Sep 16;61(3):816-835. Epub 2022 Feb 16.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.

Objective: Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive-compulsive disorder/symptoms (OCD/OCS). During the COVID-19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS.

Method: In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS-CoV-2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/-) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS-CoV-2 at the start of the pandemic and re-assessed OCS 3 months later.

Results: In Study 1, UP was higher in the OCS+ compared to the OCS- group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS-CoV-2, but not for infection itself.

Conclusions: Exaggeration of one's personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample.

Practitioner Points: Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well-being in the face of danger or uncertainty. The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive-compulsive disorder and may also be involved in the development of the disorder. This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism.
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http://dx.doi.org/10.1111/bjc.12362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111568PMC
September 2022

Therapists' Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder.

Behav Ther 2022 01 21;53(1):23-33. Epub 2021 May 21.

University Medical Center Hamburg-Eppendorf.

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists' beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists' cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD. Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP-, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS). TAF was higher in the ERP- than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP- therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists' actual clinical practices. Therapists' cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.
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http://dx.doi.org/10.1016/j.beth.2021.05.004DOI Listing
January 2022

Therapists' Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder.

Behav Ther 2022 01 21;53(1):23-33. Epub 2021 May 21.

University Medical Center Hamburg-Eppendorf.

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists' beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists' cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD. Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP-, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS). TAF was higher in the ERP- than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP- therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists' actual clinical practices. Therapists' cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.
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http://dx.doi.org/10.1016/j.beth.2021.05.004DOI Listing
January 2022

When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic.

J Anxiety Disord 2021 12 30;84:102493. Epub 2021 Oct 30.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.

The outbreak of the COVID-19 pandemic has particularly affected people with obsessive-compulsive disorder (OCD). Exacerbation of obsessive-compulsive symptoms (OCS) has been suspected for those with contamination-related OCD (C-OCD). However, the course of OCS over the ongoing pandemic remains unclear. We assessed 268 participants with OCD (n = 184 with C-OCD) in an online survey at the beginning of the pandemic in Germany, reassessing 179 participants (66.8%, 104 C-OCD) three months later. We assessed severity of OCD (OCI-R), depression (PHQ-9), experiential avoidance, as well as functional and dysfunctional beliefs. Overall, OCS and depressive symptoms did not substantially change over time. However, when people with and without C-OCD were compared, symptoms improved in patients without C-OCD (nC-OCD) but remained stable in patients with C-OCD over time. Symptom improvement was associated with male gender, higher initial OCI-R, and nC-OCD. Experiential avoidance and beliefs at the beginning of the pandemic did not generally predict change in OCS. People with OCD, particularly those with nC-OCD, showed tentative signs for signs of adapting, whereas distress in those with C-OCD remained at a high level, underlining the burden for these patients. Clinicians should be informed about how to maintain effective treatment for C-OCD during a pandemic.
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http://dx.doi.org/10.1016/j.janxdis.2021.102493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590107PMC
December 2021

Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators.

Cogn Neuropsychiatry 2021 11 25;26(6):394-407. Epub 2021 Aug 25.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD.

Methods: Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance.

Results: Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits.

Conclusions: Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.
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http://dx.doi.org/10.1080/13546805.2021.1967733DOI Listing
November 2021

Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators.

Cogn Neuropsychiatry 2021 11 25;26(6):394-407. Epub 2021 Aug 25.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD.

Methods: Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance.

Results: Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits.

Conclusions: Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.
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http://dx.doi.org/10.1080/13546805.2021.1967733DOI Listing
November 2021

Predictors of trajectories of obsessive-compulsive symptoms during the COVID-19 pandemic in the general population in Germany.

Transl Psychiatry 2021 05 27;11(1):323. Epub 2021 May 27.

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

The COVID-19 pandemic has been associated with an increase in obsessive-compulsive disorder/symptoms (OCD/OCS). However, knowledge is limited regarding the trajectories of OCS during the pandemic, as well as their predictors and mechanisms (e.g., experiential avoidance, EA). The aim of this study was to describe the trajectories of OCS and the identification of associated factors. We assessed 1207 participants of the general population in March 2020 (t1) and June 2020 (t2). Pre-pandemic data was available from March 2014 for a subsample (n = 519). To define trajectories, we determined OCS status (OCS+/-). We performed a hierarchical multinomial logistic regression to investigate predictors of trajectories. Between t1 and t2, 66% of participants had an asymptomatic trajectory (OCS-/OCS-); 18% had a continuously symptomatic trajectory (OCS+/OCS+). Ten percent had a delayed-onset trajectory (OCS-/OCS+), and the recovery trajectory group (OCS+/OCS-) was the smallest group (6%). Higher education reduced the odds of an OCS+/OCS- trajectory. OCS in 2014 was associated with increased odds of showing an OCS+/OCS+ or OCS-/OCS+ trajectory. When EA at t1 and change in EA from t1 to t2 were added to the model, higher EA at t1 was associated with increased odds of scoring above the cut score on one or more of the assessments. A higher decrease in EA from t1 to t2 reduced the probability of showing an OCS+/OCS+ and an OCS-/OCS+ trajectory. While the current data supports a slight increase in OCS during the pandemic, trajectories differed, and EA seems to represent an important predictor for an unfavorable development.
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http://dx.doi.org/10.1038/s41398-021-01419-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155650PMC
May 2021

Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression.

Sci Rep 2021 04 12;11(1):7861. Epub 2021 Apr 12.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Although awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of "symptoms" and "quality". Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.
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http://dx.doi.org/10.1038/s41598-021-87198-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041905PMC
April 2021

Negative self-conscious emotions in women with borderline personality disorder as assessed by an Implicit Association Test.

Personal Disord 2021 09 19;12(5):456-465. Epub 2020 Nov 19.

Institute of Psychology, Johannes Gutenberg-Universität Mainz.

Shame and guilt are vital in borderline personality disorder (BPD), and previous research using explicit measures has consistently found elevated levels of these self-conscious emotions (SCE) in those with BPD. However, these measures cannot elucidate implicit processes that are equally important, as they guide the perceptions of the self and influence behavioral responses. Thus, we aimed to extend the research on SCE in BPD utilizing an indirect latency-based measure. A total of 29 female inpatients with BPD and 21 healthy women were assessed with a shame and a guilt self-concept Implicit Association Test (IAT). These two tasks use reaction time measurements to determine the relative strengths of associations between the self versus others and shame versus pride and guilt versus innocence. In addition, participants completed questionnaires capturing shame, guilt, and BPD symptoms. Women with BPD displayed significantly more shame- and guilt-prone implicit self-concepts than the control group ( = 1.2 and = 0.7, respectively). They also scored significantly higher on explicit measures of shame and guilt. Although explicitly and implicitly assessed shame and guilt were strongly associated with borderline pathology, multivariate models indicated that solely self-reported, but not implicitly measured, guilt was consistently related to all BPD outcomes. Shame was only associated with the number of BPD criteria. This study extends previous findings on SCE in BPD, in that women with BPD do not only explicitly conceive themselves as more shame- and guilt-prone but also exhibit implicitly more shame and guilt self-concepts than healthy controls. Our results may hold clinical and therapeutic implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000467DOI Listing
September 2021

Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?

J Anxiety Disord 2021 01 5;77:102329. Epub 2020 Nov 5.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany.

The COVID-19 pandemic has prompted global measures to prevent infection. Experts assume that it is particularly affecting people with obsessive-compulsive disorder (OCD), especially those with washing compulsions. Data, however, are currently lacking. 394 participants with OCD (n = 223 washers) participated in an online survey. Change in severity of OCD symptoms, reasons participants reported for the change (e.g., reduced mobility, reduced availability of cleaning products, economic factors, interpersonal conflicts), as well as participants' beliefs and experience associated with COVID-19 were assessed. 72 % of the participants reported an increase in OCD. This increase was significantly stronger in washers compared to non-washers. The worsening of symptoms was primarily associated with reduced mobility and interpersonal conflicts. Dysfunctional hygiene-related beliefs were significantly higher in washers than non-washers and were associated with greater symptom progression. Washers were more confident than non-washers about providing other people with helpful advice related to infection preventions. Washers, however, received more negative feedback from others in response to the advice they provided than non-washers. The majority of participants with OCD were negatively affected by the COVID-19 pandemic, and the negative effects were more pronounced in washers than in non-washers. Rapid interventions for OCD should be implemented to prevent long-term deterioration.
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http://dx.doi.org/10.1016/j.janxdis.2020.102329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644184PMC
January 2021

Unguided Internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A randomized controlled trial.

Depress Anxiety 2020 12 10;37(12):1208-1220. Epub 2020 Nov 10.

Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Background: Many individuals with obsessive-compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet-based cognitive-behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third-wave approaches for the treatment of OCD symptoms.

Methods: A total of 128 individuals with self-reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care-as-usual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale-Brown Obsessive-Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per-protocol sample with at least 60 minutes utilization.

Results: The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η²  = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η²  = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self-esteem (η²  = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention.

Conclusions: The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non-compliance remains a challenge, this topic needs further research.
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http://dx.doi.org/10.1002/da.23105DOI Listing
December 2020

Unguided Internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A randomized controlled trial.

Depress Anxiety 2020 12 10;37(12):1208-1220. Epub 2020 Nov 10.

Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Background: Many individuals with obsessive-compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet-based cognitive-behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third-wave approaches for the treatment of OCD symptoms.

Methods: A total of 128 individuals with self-reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care-as-usual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale-Brown Obsessive-Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per-protocol sample with at least 60 minutes utilization.

Results: The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η²  = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η²  = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self-esteem (η²  = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention.

Conclusions: The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non-compliance remains a challenge, this topic needs further research.
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http://dx.doi.org/10.1002/da.23105DOI Listing
December 2020

Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability.

Eur Arch Psychiatry Clin Neurosci 2021 Sep 5;271(6):1179-1191. Epub 2020 Nov 5.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

According to psychodynamic and cognitive models of obsessive-compulsive disorder (OCD), anger and aggression play an important role in the development and maintenance of the disorder. (Sub-) clinical samples with OCD have reported higher anger and anger suppression. Patients with checking-related symptoms of OCD showed a less aggressive self-concept as assessed by an Implicit Association Test (IAT). This study assessed anger and aggressiveness self-concepts in OCD as well as possible mediators of the link between OCD and aggressiveness. A total of 48 patients with OCD and 45 healthy controls were included. Measures included the State-Trait Anger Expression Inventory-II and an aggressiveness self-concept IAT (Agg-IAT). An inflated sense of responsibility, non-acceptance of emotions, and social desirability were tested as mediators. As expected, patients with OCD reported higher trait anger and anger suppression compared to healthy controls. Contrary to hypotheses, the aggressiveness self-concept (Agg-IAT) did not differ between groups. The inflated sense of responsibility mediated the relationship between group and anger suppression. Non-acceptance of negative emotions mediated the relationship between group and trait anger, as well as anger suppression. However, comorbidities and medication may account for some effect in anger suppression. Elevated trait anger and anger suppression in OCD patients could be explained by dysfunctional beliefs or maladaptive emotion regulation strategies. Emotion regulation therapy might help to enhance awareness and acceptance of emotions and possibly improve treatment outcomes.
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http://dx.doi.org/10.1007/s00406-020-01199-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354876PMC
September 2021

Session-specific effects of the Metacognitive Group Training for Obsessive-Compulsive Disorder: significant results for thought control.

Sci Rep 2020 10 20;10(1):17816. Epub 2020 Oct 20.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

The investigation of the session-specific effects is central for the understanding of psychological interventions. For the present study, we investigated the session-specific effects of the Metacognitive Group Training for Obsessive-Compulsive Disorder (MCT-OCD), which was revised based on data of a pilot study. Thirty-four outpatients with OCD participated in the MCT-OCD once a week over 8 weeks. Different metacognitive beliefs (e.g., thought control) and cognitive beliefs (e.g., intolerance of uncertainty), OC symptoms, as well as associated comorbid symptoms were assessed before and after each session. Linear mixed effects models showed that patients' obsessions and compulsions, thought control, the belief of being well informed about the disorder, and action fusion improved over the course of the training. The only session-specific effect emerged for thought control, which improved immediately after the respective module. We were able to replicate the findings of the pilot study and thus corroborate the session-specific effect of the module targeting thought control. Moreover, we generated information on the mode of action of the individual modules of the MCT-OCD that allows a more in-depth evaluation of the intervention. Notably, we were able to eliminate the adverse effects of the pilot version of the MCT-OCD.Trial Registration: German Clinical Trials Register (Deutsches Register Klinischer Studien [DRKS]; DRKS-ID: DRKS00013539; registration date: 22/02/2018).
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http://dx.doi.org/10.1038/s41598-020-73122-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576173PMC
October 2020

Cortisol, DHEA and DHEA-S during exposure therapy in patients with obsessive-compulsive disorder - secretion patterns and prediction of treatment response.

Psychiatry Res 2020 09 10;291:113288. Epub 2020 Jul 10.

University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.

The cortisol response in patients with obsessive-compulsive disorder (OCD) during exposure with response prevention (ERP), a stressful but very effective psychotherapeutic treatment, has shown contradictory findings in three prior studies with low sample sizes. In a larger cohort of 51 patients with OCD we repeatedly measured subjective units of distress (SUD) and the adrenocortical stress hormones cortisol, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) in saliva during the very first session of ERP and on the day before. Expectedly, SUD were increased on the ERP day before the session and further rose during ERP, but salivary cortisol and DHEA were statistically indistinguishable from the comparison condition. Interestingly, DHEA-S was significantly elevated throughout the ERP versus the comparison day, but did not further increase in acute response to ERP. According to an explorative analysis in a subsample, hormone levels on the comparison or the ERP day did not predict anti-OCD treatment response one month later. These results corroborate our prior findings of cortisol non-response despite considerable subjective stress in ERP. The role of DHEA-S in anticipatory anxiety and the effects of augmentative cortisol therapy in ERP need further study.
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http://dx.doi.org/10.1016/j.psychres.2020.113288DOI Listing
September 2020

Metacognitive Training for Obsessive-Compulsive Disorder: a study protocol for a randomized controlled trial.

BMC Psychiatry 2020 07 6;20(1):350. Epub 2020 Jul 6.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.

Background: A high number of patients with obsessive-compulsive disorder (OCD) do not receive cognitive-behavioral therapy with exposure and response prevention, which is the most effective treatment for OCD. Therefore, Metacognitive Training for OCD (MCT-OCD) was developed, which is a structured group therapy aiming at the modification of dysfunctional (meta-)cognitive biases, beliefs and coping styles. It can be administered by less trained personnel, thus may reach a higher number of patients. An uncontrolled pilot study (MCT-OCD pilot version) provided first evidence that the training is highly accepted by patients; OC symptoms decreased with a high effect size (η = 0.50). The aim of the present study is to address the shortcomings of the pilot study (e.g., no control group) and to assess the efficacy of the revised version of the MCT-OCD in the framework of a randomized controlled trial.

Methods: Eighty patients with OCD will be recruited. After a blinded assessment at baseline (-t1), patients will be randomly assigned either to the intervention group (MCT-OCD; n = 40) or to a care as usual control group (n = 40). The MCT-OCD aims to enhance patients' metacognitive competence in eight modules by addressing dysfunctional (meta-)cognitive biases and beliefs associated with OCD (e.g., intolerance of uncertainty). After 8 weeks, patients will be invited to a post assessment (t1), and then they will receive a follow-up online questionnaire 3 months following t1 (t2). The primary outcome is the Y-BOCS total score, and the secondary outcomes include the HDRS, OCI-R, OBQ-44, MCQ-30, WHOQOL-BREF, BDI-II, and subjective appraisal ratings of the MCT-OCD. We expect that OC symptoms will decrease more in the intervention group compared with the care as usual control group from -t1 to t1 and that treatment gains will be maintained until t2.

Discussion: The planned study is the first to investigate the MCT-OCD, a promising new treatment, in a randomized controlled trial. The MCT-OCD may help to overcome existing treatment barriers for patients with OCD.

Trial Registration: German Registry for Clinical Studies ( DRKS00013539 ), 22.02.2018.
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http://dx.doi.org/10.1186/s12888-020-02648-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336399PMC
July 2020

Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial.

Psychiatry Res 2020 09 28;291:113119. Epub 2020 May 28.

University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr, 52, 20246 Hamburg, Germany.

We examined the long-term efficacy of mindfulness-based cognitive therapy (MBCT) compared to a psychoeducation group as an active control condition in patients with obsessive-compulsive disorder (OCD) with residual symptoms of OCD after cognitive behavioral therapy. A total of 125 patients were included in a bicentric, interviewer-blind, randomized, and actively controlled trial and were assigned to either an MBCT group (n = 61) or a psychoeducation group (n = 64). Patients' demographic characteristics and the results from our previous assessments have already been reported (Külz et al., 2019). At the 12-month follow-up the completion rate was 80%. OCD symptoms were reduced from baseline to follow-up assessment with a large effect, but no difference was found between groups. Exploratory analyses showed that a composite score of time occupied by obsessive thoughts, distress associated with obsessive thoughts, and interference due to obsessive thoughts differed between groups in the per-protocol analysis, with a stronger reduction in the MBCT group. At the 12-month follow-up, the two groups showed a similar reduction of symptoms. However, preliminary evidence indicates that MBCT has a superior effect on some aspects of OCD. This should be replicated in future studies.
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http://dx.doi.org/10.1016/j.psychres.2020.113119DOI Listing
September 2020

Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation.

J Med Internet Res 2020 03 26;22(3):e15312. Epub 2020 Mar 26.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s).

Objective: The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group.

Methods: We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t) and 2 weeks (t) and 4 weeks (t) later. After the t assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life.

Results: While groups did not differ regarding the change in depression from t to t (η=.007, P=.746) or t to t (η=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t to t in comparison to CAU (η=.053, P=.04) and a larger increase in activity from t to t than the pooled control groups (η=.060, P=.02). A change in depression from t to t was mediated by a change in activity from t to t. At t, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention.

Conclusions: Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval.

Trial Registration: DKRS (#DRKS00011562).
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http://dx.doi.org/10.2196/15312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146239PMC
March 2020

Advice weighting as a novel measure for belief flexibility in people with psychotic-like experiences.

Schizophr Res 2020 02 8;216:129-137. Epub 2020 Jan 8.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

Jumping to conclusions and bias against disconfirmatory evidence are two cognitive biases common in people with psychotic-like experiences and psychosis. However, many participants show comprehension problems doing traditional tasks; new paradigms with additional applied scenarios are thus needed. A large MTurk community sample (N = 1422) was recruited and subdivided into participants with high levels of psychotic-like experiences (at least 2 SD above the mean, n = 79) and participants with low levels of psychotic-like experiences (maximum 0.5 SD above the mean, n = 1110), based on the positive subscale of the Community Assessment of Psychic Experiences (CAPE). In the context of a judge-advisor system, participants made an initial estimate and then received advice that was either confirmatory or disconfirmatory. Participants then gave a new, possibly revised estimate and were allowed to seek additional advice. Participants with high levels of psychotic-like experiences gave their final assessment after receiving significantly less advice and were significantly more confident in their decision than participants with low psychotic-like experiences, in line with previous studies on jumping to conclusions and overconfidence. Contrary to the hypothesis and earlier studies, however, no deficit in belief revision was found. In fact, participants with high psychotic-like experiences weighted advice significantly higher in the condition with disconfirmatory advice, but only for the first advice they received. The increased weighting of a single piece of disconfirmatory advice can be explained by the hypersalience of evidence-hypothesis matches theory, according to which more weight is attached to the most recently available information.
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http://dx.doi.org/10.1016/j.schres.2019.12.016DOI Listing
February 2020

The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report.

Int J Psychiatry Clin Pract 2020 Jun 9;24(2):173-175. Epub 2020 Jan 9.

Hertfordshire Partnership University NHS Foundation Trust, University of Hertfordshire, Hatfield, UK.

To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD). Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples. Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder. Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.
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http://dx.doi.org/10.1080/13651501.2019.1711424DOI Listing
June 2020

Implicitly measured aggressiveness self-concepts in women with borderline personality disorder as assessed by an Implicit Association Test.

J Behav Ther Exp Psychiatry 2020 03 3;66:101513. Epub 2019 Sep 3.

Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Germany; Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany. Electronic address:

Background: Aggressiveness resulting from inappropriately intense anger plays a major role in borderline personality disorder (BPD) and research using self-report measures has consistently found elevated levels of aggression in this condition. However, while self-report assesses explicit dimensions of the self-concept, it cannot elucidate implicit processes that are at least equally important as they guide the perceptions of the self and influence behavioral responses. The present study aimed to extend the research on aggressiveness self-concepts in BPD utilizing an indirect latency-based measure.

Methods: Twenty-nine female inpatients with BPD and 21 healthy women were assessed with an aggressiveness self-concept Implicit Association Test (Agg-IAT) using reaction time measurements to determine the relative strengths of associations between the self vs. others and aggression vs. peacefulness. Additionally, participants completed self-report questionnaires capturing aggressiveness and BPD symptoms.

Results: Women with BPD had a significantly more aggressive self-concept as indicated by the Agg-IAT than the control group. Moreover, they rated themselves significantly more aggressive on all dimensions than the controls. As expected, correlations between the Agg-IAT and the self-reported aggressiveness dimensions were low (mean r = -.31).

Limitations: The modest sample size and the disregard of a clinical control group limit the generalizability and specificity of our findings.

Conclusions: This study extends prior findings on aggression in BPD in that women with BPD do not only explicitly conceive themselves as more aggressive, but also exhibit implicitly more aggressive self-concepts than healthy controls. Because implicit and explicit self-related operations are related, but distinct processes, our results may hold clinical and therapeutic implications.
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http://dx.doi.org/10.1016/j.jbtep.2019.101513DOI Listing
March 2020

Session-specific effects of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD).

Psychother Res 2020 04 9;30(4):474-486. Epub 2019 May 9.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Most studies focus on overall treatment effects by assessing symptom severity before and after treatment, but few investigate session-specific effects of an intervention. The aim of the present study was to elucidate session-specific effects of a group therapy for obsessive-compulsive disorder (OCD) that targets cognitive biases known as the Metacognitive Training for OCD (MCT-OCD). In an uncontrolled pilot trial, 44 inpatients with OCD participated in the MCT-OCD once a week over four weeks. Before and after each session, patients answered questionnaires on thought monitoring, control of thoughts, obsessions, compulsions, and mood. Primary analyses using linear mixed-effect models showed that the module on control of thoughts (within-session effect) significantly reduced patients' control of thoughts. Exploratory analyses displayed an improvement in thought monitoring, control of thoughts, obsessions, and compulsions over the treatment period. Control of thoughts decreaed after the module on biased attention/biased cognitive networks and compulsions reduced one week after the module on overestimation of threat/responsibility (between-session effect). More compulsions were reported one week after the module on thought-action fusion/control of thoughts. Certain MCT-OCD modules seemed to improve specific cognitive biases that might in turn act as mechanisms of change. The results are being used to revise the MCT-OCD.
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http://dx.doi.org/10.1080/10503307.2019.1613582DOI Listing
April 2020

Treatments used for obsessive-compulsive disorder-An international perspective.

Hum Psychopharmacol 2019 01 10;34(1):e2686. Epub 2019 Jan 10.

Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.

Objective: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD).

Methods: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated.

Results: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD.

Conclusions: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.
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http://dx.doi.org/10.1002/hup.2686DOI Listing
January 2019

Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ).

Psychiatry Res 2019 02 13;272:265-274. Epub 2018 Dec 13.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

There is an ongoing debate about the specificity of dysfunctional beliefs in patients with obsessive-compulsive disorder (OCD) as some of these beliefs seem to be relevant in depressed patients as well. The present study aimed to elucidate the specificity of dysfunctional beliefs using the newly developed Beliefs Questionnaire (BQ). A combination of an online assessment and clinical interviews was carried out. One hundred thirty OCD patients (M = 38.7 years; 68% women) were compared to 85 patients with depression (M = 36.6 years; 75% women) and 220 nonclinical controls (M = 38.9 years; 71% women) on the BQ, which contains 13 items tapping cognitive beliefs. The BQ was validated against the Obsessive Beliefs Questionnaire (OBQ). Patients with OCD and depression scored higher on the BQ compared to nonclinical controls. OCD patients displayed higher values on overestimation of threat and the fear of becoming insane. Correlation between BQ and OBQ total scores was high (r = 0.751), supporting the validity of the new scale. Our results show that two beliefs are OCD-specific. However, the BQ covers mainly transdiagnostic features and should be replicated with the inclusion of an anxiety disorder sample.
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http://dx.doi.org/10.1016/j.psychres.2018.12.070DOI Listing
February 2019

Long-term efficacy of Metacognitive Training for Depression (D-MCT): A randomized controlled trial.

Br J Clin Psychol 2019 Sep 16;58(3):245-259. Epub 2018 Dec 16.

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.

Objectives: The availability of treatment for depression needs to be improved. Among the barriers are the dearth of group programmes and the high demand of many programmes with regard to staff expertise. The Metacognitive Training for Depression (D-MCT) is a new, easy-to-administer, cognitive behaviour-based group intervention. In a previous 6-month trial, D-MCT was highly accepted by patients and efficacious compared to a control treatment. The aim of the current study was to examine whether the effects of the D-MCT can be sustained over 3.5 years.

Design: Long-term follow-up of a randomized controlled trial.

Methods: A total of 84 patients with a confirmed diagnosis of unipolar depressive disorder were enrolled in a randomized, controlled, assessor-blind, parallel group trial comparing two interventions added to usual care: D-MCT and general health training (HT). Patients were reassessed 3.5 years after the interventions were terminated. Primary outcome was the Hamilton Depression Rating Scale. Self-assessed depressive symptom severity (BDI), dysfunctional cognitive (DAS) and metacognitive (MCQ) beliefs, self-esteem (RSE), and quality of life (WHOQOL-BREF) served as secondary outcomes.

Results: Primary intention-to-treat analyses using analysis of covariance showed negative results, and only secondary post-hoc analyses utilizing latent growth modelling demonstrated superiority of D-MCT over HT with regard to the long-term course of depressive symptom severity and cognitive and metacognitive outcomes as well as physical and psychological quality of life.

Conclusions: Findings suggest that D-MCT may be a promising add-on treatment for unipolar depression that should be investigated in large multi-centre studies. Independent replications are needed.

Practitioner Points: Clinical implications: The current study shows tentative evidence that positive effects of the D-MCT reported at the 6-month follow-up assessment were sustained over 3.5 years. Potential positive effects regard severity of depression, dysfunctional cognitive, and metacognitive beliefs as well as quality of life. If positive results are replicated with less trained therapists, D-MCT offers the possibility of providing a simple and easy-to-administer CBT-based group treatment for depression with long lasting effects.

Limitations: Sample size was small; a large-scale multi-centre trial would be desirable to gain high statistical power with an adequate sample size and to allow the investigation of possible allegiance effects. D-MCT was delivered as an add-on intervention and not as a stand-alone intervention.
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http://dx.doi.org/10.1111/bjc.12213DOI Listing
September 2019

Mindfulness-based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial.

Eur Arch Psychiatry Clin Neurosci 2019 Mar 16;269(2):223-233. Epub 2018 Nov 16.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Up to one-third of individuals with obsessive-compulsive disorder (OCD) do not benefit from evidence-based psychotherapy. We examined the efficacy of mindfulness-based cognitive therapy (MBCT) as a complementary treatment option. In a prospective, bicentric, assessor-blinded, randomized, and actively controlled clinical trial, 125 patients with OCD and residual symptoms after cognitive behavioral therapy (CBT) were randomized to either an MBCT group (n = 61) or to a psychoeducational group (OCD-EP; n = 64) as an active control condition. At post-treatment, there was no significant benefit of MBCT over OCD-EP with the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) as the primary outcome measure, but with the Obsessive-Compulsive Inventory [OCI-R; F(1, 101) = 5.679, p = .036, effect size η = 0.053]. Moreover, the response rate and the improvement on secondary outcomes such as obsessive beliefs and quality of life was significantly larger in the MBCT group. Non-completion rates were below 10%. At the 6-month follow-up, OC symptoms were further improved in both groups; group differences were no longer significant. Our findings suggest that MBCT, compared to a psychoeducational program, leads to accelerated improvement of self-reported OC symptoms and secondary outcomes, but not of clinician-rated OC symptoms. In the midterm, both interventions yield similar and stable, but small improvements, suggesting that additional treatment options may be necessary.
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http://dx.doi.org/10.1007/s00406-018-0957-4DOI Listing
March 2019

Course and stability of cognitive and metacognitive beliefs in depression.

Depress Anxiety 2018 12 12;35(12):1239-1246. Epub 2018 Sep 12.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Maladaptive cognitive beliefs as measured by the Dysfunctional Attitudes Scale (DAS) increase vulnerability to depression. Maladaptive metacognitive beliefs as measured by the Metacognitive Questionnaire-30 (MCQ-30) are also thought to contribute to depression. However, the long-term stability of metacognitive beliefs in depression has not yet been investigated. It is unclear whether metacognitive beliefs can add explanatory power to depression above and beyond maladaptive cognitive beliefs. The aim of the present study was to investigate the role and stability of cognitive and metacognitive maladaptive beliefs in depression. Eighty-four patients with depression were assessed with the DAS, three subscales of the MCQ-30 (positive metacognitive beliefs about worry and rumination [PB]; negative metacognitive beliefs about the uncontrollability of rumination [NB]; metacognitive beliefs concerning the need to control one's thoughts [NFC]), the Hamilton Depression Rating Scale, and the Beck Depression Inventory at baseline and were reassessed 3.5 years later. Analyses using a longitudinal latent growth model showed that change on the DAS and baseline scores and change on the MCQ-30 (NB and NFC) significantly predicted change in self-rated depressive symptoms over 3.5 years. However, the DAS explained more additional variance than the integration of the MCQ-30 subscales. Subscales of the MCQ-30 were more stable than the DAS. Although cognitive and metacognitive maladaptive beliefs were both predictors of depression, the DAS was a better predictor than the MCQ-30 subscales. Nevertheless, because maladaptive metacognitive beliefs were more stable than maladaptive cognitive beliefs, they should be considered an important underlying vulnerability factor for depression.
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http://dx.doi.org/10.1002/da.22834DOI Listing
December 2018

It can't hurt, right? Adverse effects of psychotherapy in patients with depression.

Eur Arch Psychiatry Clin Neurosci 2019 Aug 7;269(5):577-586. Epub 2018 Aug 7.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Despite growing awareness of occasional adverse effects of psychological treatments, only a few instruments cover side effects and other unwanted effects of psychotherapy. For the present study, the Positive and Negative Effects of Psychotherapy Scale (PANEPS) was evaluated in a population of individuals with depression who had completed at least one course of face-to-face psychotherapy. A total of 135 individuals with a current or previous depressive episode as verified by a diagnostic interview filled out the online version of the PANEPS, which is designed to capture both positive and adverse events. Factor analysis yielded four dimensions: positive effects, side effects, malpractice, and unethical conduct. Internal consistency of the individual subscales was satisfactory to excellent (Cronbach's α: 0.72 and 0.92). Positive effects were reported by virtually all patients (95.6%). At the same time, approximately half of the sample noted at least one adverse event (52.6%). Among these, side effects (38.5%) and malpractice (26.7%) were significantly more prevalent than unethical conduct (8.1%). As expected, positive effects were negatively correlated with adverse events. Our results challenge the common clinical assumption that some degree of destabilization is necessary for symptom improvement. The survey was conducted anonymously, and the sample underwent diagnostic verification. The results indicate a need for improved treatment guidelines and mechanisms to monitor treatment.
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http://dx.doi.org/10.1007/s00406-018-0931-1DOI Listing
August 2019
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