Enhancing CBT Adherence in Refractory Obsessive Compulsive Disorder with MI

描述(由申请人提供)：强迫症是世界范围内导致残疾的主要原因之一。由暴露和仪式预防(EX/RP)组成的认知行为疗法(CBT)是一种有效的强迫症治疗方法，但其有效性受到患者拒绝、磨耗和/或对EX/RP方案的不良遵守的限制。对于这些对EX/RP耐药的患者来说，EX/RP的结果很差。动机访谈是一种结构化的治疗方法，通过探索和解决矛盾心理来增强改变的动机。MI干预已成功地用于酒精滥用和其他障碍，以增加治疗进入、保留和依从性，并改善治疗耐药患者的结果。然而，对于对EX/RP耐药的强迫症患者来说，MI还没有得到系统的研究。这项探索性研究拨款(R34)的目标是开发和测试EX/RP+MI干预措施，旨在增加EX/RP抵抗的强迫症患者的EX/RP进入、保留和依从性。作为焦虑症诊所(ADC)和焦虑症治疗与研究中心(CTSA)之间的合作项目，该项目将建立在我们富有成效的13年合作历史的基础上，受益于我们已建立的合作基础设施，并利用我们与强迫症患者积累的专业知识。如果在本文建议的开放试验中，在标准的EX/RP治疗的基础上增加短暂的MI干预显著改善EX/RP耐药患者的结果，这些数据将被用于支持一项更大规模的对照试验，以证实EX/RP+MI的疗效。如果EX/RP+MI干预有效，它可能会将EX/RP已被证实的力量带给更多的强迫症患者，从而极大地影响公众健康。这项探索性研究补助金(R34)的具体目标是：1)将MI和EX/RP整合为一种新的干预措施(EX/RP+MI)，适用于对EX/RP耐药的强迫症患者(即拒绝、退出或部分坚持以前的EX/RP治疗的患者)。在第一年，我们将根据我们的EX/RP专业知识，培训和咨询MI专家，以及8个测试案例的经验，开发一份EX/RP+MI手册。2)探讨这种新型的EX/RP+MI干预措施对改善EX/RP抵抗的强迫症患者预后的效果。在第二年和第三年，我们将在24名对EX/RP治疗反应不佳的门诊强迫症患者中进行这种EX/RP+MI干预的公开试验。

DESCRIPTION (provided by applicant): OCD is one of the leading causes of disability world-wide. Cognitive-behavioral therapy (CBT) consisting of exposure and ritual prevention (EX/RP) is an efficacious OCD treatment, but its effectiveness is limited by patient refusal, attrition, and/or poor adherence to the EX/RP protocol. For these EX/RP-resistant patients, EX/RP outcome is poor. Motivational Interviewing (MI) is a structured therapeutic method for enhancing motivation to change by exploring and resolving ambivalence. MI Interventions have been used successfully in alcohol abuse and other disorders to increase treatment entry, retention, and adherence and to enhance outcome in treatment-resistant patients. However, MI has not been systematically studied for EX/RP-resistant OCD patients. The goal of this Exploratory Research Grant (R34) is to develop and test an EX/RP+MI intervention aimed at increasing EX/RP entry, retention, and adherence in EX/RP-resistant OCD patients. Proposed as a collaboration between the Anxiety Disorders Clinic (ADC) and the Center for the Treatment and Study of Anxiety (CTSA), this project will build on our productive thirteen-year collaborative history, benefit from our established collaborative infrastructure, and exploit our cumulative expertise with OCD patients. If adding a brief MI intervention to standard EX/RP treatment substantially improves the outcome of EX/RP-resistant patients in the open trial proposed herein, these data will be used to support a larger controlled trial to confirm the efficacy of EX/RP+MI. If the EX/RP+MI intervention is effective, it could substantially impact public health by bringing the proven power of EX/RP to a much larger population of OCD sufferers. The specific aims of this Exploratory Research Grant (R34) are: 1) To integrate MI and EX/RP into a novel intervention (EX/RP+MI) for EX/RP-resistant OCD patients (i.e., patients who refused, dropped out, or partially adhered to prior EX/RP treatment). During Year 1, we will develop an EX/RP+MI manual based on our EX/RP expertise, training and consultation with an MI expert, and experience with 8 test cases. 2) To explore the efficacy of this novel EX/RP+MI intervention at improving OCD outcome in EX/RP-resistant OCD patients. During Years 2 and 3, we will conduct an open trial of this EX/RP+MI intervention in 24 EX/RP-resistant OCD outpatients who had a poor response to prior EX/RP treatment.