Imagery Rescripting (ImRs) as an Adjunctive Treatment to Exposure and Response Prevention (ERP)-Resistant Obsessive-Compulsive Disorder: A Case Study

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Abstract

Exposure and response prevention (ERP), a specific type of Cognitive and Behaviour Therapy, is well recognised as the first-line psychological treatment in obsessive-compulsive disorder (OCD), either alone or in combination with selective serotonin reuptake inhibitor pharmacotherapy. However, given that up to half of patients suffering from OCD do not experience a clinically significant reduction in symptoms following ERP, further treatment options for treatment-resistant OCD are needed. Initial research into using ImRs as a psychological adjunct for treatment-resistant OCD has been encouraging. We provide a detailed case study of a 61-year-old male who continued, following ERP treatment, to suffer debilitating OCD symptoms of compulsive checking to prevent making mistakes. Following ERP, the individual received two sessions of ImRs as a therapy adjunct, which resulted in a further reduction of 56% in OCD symptoms. The individual reported associated improvements in mood, life satisfaction, and occupational and interpersonal relationships. This case study describes how ImRs can be incorporated into ERP treatment for OCD. Details of the ERP and ImRs treatment are provided, along with transcript excerpts to highlight the ImRs process. Further research is needed to enhance understanding of mechanisms and optimal deployment of ImRs in treatment sequencing for OCD sufferers.

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Diagnostic and Statistical Manual of Mental Disorders : DSM-5-TR

American Psychiatric Association (2022)

"The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), is the most comprehensive, current, and critical resource for clinical practice available to today's mental health clinicians and researchers. DSM-5-TR includes fully revised text and references, updated diagnostic criteria and ICD-10-CM codes since DSM-5 was published in 2013. It features a new disorder, prolonged grief disorder, as well as codes for suicidal behavior available to all clinicians of any discipline without the requirement of any other diagnosis. With contributions from over 200 subject matter experts, this updated volume boasts the most current text updates based on the scientific literature. Now in four-color and with the ability to authenticate each printed copy, DSM-5-TR provides a cohesive, updated presentation of criteria, diagnostic codes, and text. This latest volume offers a common language for clinicians involved in the diagnosis and study of mental disorders and facilitates an objective assessment of symptom presentations across a variety of clinical settings-inpatient, outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care. Important updates in DSM-5-TR include 1) fully revised text for each disorder with updated sections on associated features, prevalence, development and course, risk and prognostic factors, culture, diagnostic markers, suicide, differential diagnosis, and more; 2) addition of prolonged grief disorder (PGD) to Section II; 3) over 70 modified criteria sets with helpful clarifications since publication of DSM-5; 4) fully updated Introduction and Use of the Manual to guide usage and provide context for important terminology; 5) considerations of the impact of racism and discrimination on mental disorders integrated into the text; 6) new codes to flag and monitor suicidal behavior, available to all clinicians of any discipline and without the requirement of any other diagnosis; 7) fully updated ICD-10-CM codes implemented since 2013, including over 50 coding updates new to DSM-5-TR for substance intoxication and withdrawal and other disorders"--

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The Yale-Brown Obsessive Compulsive Scale

Wayne K Goodman (1989)

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Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators.

Bunmi Olatunji, Tim Davis, Mark B Powers … (2013)

The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) as well as potential moderators that may be associated with outcome. A literature search revealed sixteen randomized-controlled trials (RCTs) with a total sample size of 756 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 1.39) and at follow-up (Hedges's g = 0.43). Subsequent analyses revealed few moderators of CBT efficacy. Neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size. Similarly, effect size did not vary as a function of 'type' of CBT, treatment format, treatment integrity assessment, blind assessment, age of onset, duration of symptoms, percentage of females, number of sessions, or percent comorbidity. However, active treatments showed smaller effect sizes when compared to placebo controls than when compared to waitlist controls. Effect sizes were also smaller for adult RCTs than child RCTs. Likewise, older age was associated with smaller effect sizes. However, an association between age and effect size was not observed when examining child and adult samples separately. This review indicates that while CBT is efficacious in the treatment of OCD, more research is needed to identify processes that may predict more favorable treatment responses. Copyright © 2012 Elsevier Ltd. All rights reserved.