Factors Associated with the Compliance of Cognitive Behavioral Therapy for Obsessive Compulsive Disorder

Ji Sun Kim; Hye Youn Park; Sung Nyun Kim; Min-Sup Shin; Tae Hyon Ha; Jun Soo Kwon

doi:10.4306/jknpa.2013.52.6.409

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Kim, Park, Kim, Shin, Ha, and Kwon: Factors Associated with the Compliance of Cognitive Behavioral Therapy for Obsessive Compulsive Disorder

Original Article

Journal of Korean Neuropsychiatric Association 2013; 52(6): 409-416.

Published online: 30 November 2013

DOI: https://doi.org/10.4306/jknpa.2013.52.6.409

Factors Associated with the Compliance of Cognitive Behavioral Therapy for Obsessive Compulsive Disorder

Ji Sun Kim, MD¹, Hye Youn Park, MD^1,², Sung Nyun Kim, MD, PhD^2,³, Min-Sup Shin, PhD², Tae Hyon Ha, MD, PhD¹, Jun Soo Kwon, MD, PhD^2,^3,⁴

¹Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.

²Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

³Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea.

⁴Department of Brain and Cognitive Sciences-WCU Program, College of Natural Sciences, Seoul National University, Seoul, Korea.

Address for correspondence: Jun Soo Kwon, MD, PhD. Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel +82-2-2072-2972, Fax +82-2-747-9063, kwonjs@snu.ac.kr

Received 28 July 2013 Revised 26 August 2013 Accepted 14 September 2013

Abstract

Objectives

Non-completion rate of cognitive behavioral therapy (CBT) for Obsessive Compulsive Disorder (OCD) was reported to be higher than expected and it could interfere with the effectiveness of treatment. The aim of this study was to investigate predictors of treatment non-completion and to compare the effectiveness of CBT for OCD between completers and non-completers.

Methods

We studied 107 patients with a principal diagnosis of OCD who initiated a 13-week CBT for OCD from June 2004 to June 2011. Demographic and clinical characteristics, psychiatric co-morbidity, and medication of 20 participants who did not complete therapy were compared with those of treatment completers (n=87). Clinical Global Impression scores were also compared between the two groups in order to evaluate the effect of CBT for OCD at the 13th week.

Results

The results showed a difference in marital status between treatment completers and non-completers : more non-completers were not married (p=0.04). Patients with aggressive obsessions at baseline showed a trend (p=0.06) toward lower treatment completion than those with only non-aggressive obsession. In addition, the non-completer group showed a trend of not being medicated (p=0.08). No other differences were observed between completers and non-completers. The 13th week Clinical Global Impression-Improvement scores were significantly different ; completers (2.5±0.8) and non-completers (3.2±0.8) (p<0.001).

Conclusion

In this study, we confirmed that CBT could affect symptom improvement of OCD and treatment non-completion interfered with effectiveness of CBT. However, in the current state of our knowledge, no factor is clinically applicable as a predictor of treatment non-completion. Therefore, these results suggest that clinicians should monitor compliance during CBT for OCD patients.

Keywords: Obsessive Compulsive Disorder, Cognitive behavioral therapy, Treatment non-completion, Factors associated with the non-completion

Figures and Tables

Fig. 1

Changes of CGI-S scores of completers and non-completers at baseline and end-point. CGI-S : Clinical Global Impression-Severity.

Table 1

Demographic and clinical characteristics of the subjects

^* : Pearson's chi-square test was used for categorical variables, and the Mann-Whitney test was used for continuous variables, ^† : Includes unemployment, retirement. Full-time students and house-wives were considered currently employed, ^‡ : Includes somatic obsession, checking, counting, repeating compulsion, ^§ : Patients who had higher obsession scores in Y-BOCS total scores, ^∥ : Patients who had higher compulsion scores in Y-BOCS total scores. SD : Standard deviation, DY-BOCS : Dimensional Yale-Brown Obsessive-Compulsive Scale, Y-BOCS : Yale-Brown Obsessive-Compulsive Scale, CGI-S : Clinical Global Impression-Severity, rated as : 1, normal, not at all ill ; 2, borderline mentally ill ; 3, mildly ill ; 4, moderately ill ; 5, markedly ill ; 6, severely ill ; or 7, extremely ill, CGI-I : Clinical Global Impression-Improvement, rated as : 1, very much improved ; 2, much improved ; 3, minimally improved ; 4, no change ; 5, minimally worse ; 6, much worse ; or 7, very much worse

Table 2

The psychiatric comorbidities of the subjects

Bipolar NOS : Bipolar disorder not otherwise specified, DSM-IV : Diagnostic and Statistical Manual of Mental Disorders, 4th edition

Table 3

Comparison of the psychiatric medication between the completers and non-completers

^* : One-completer's medication is missing due to not valid information, ^† : Fisher's Exact test was used, ^‡ : Anti-epileptic drugs or benzodiazepine mono therapy. SSRI : Selective Serotonin Reuptake Inhibitor

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