Enhancing CBT Adherence in Refractory Obsessive Compulsive Disorder with MI

描述（由申请人提供）：强迫症是全球残疾的主要原因之一。认知行为疗法（CBT）由暴露和仪式预防（EX/RP）组成，是一种有效的强迫症治疗方法，但其有效性受到患者拒绝，磨损和/或对EX/RP方案依从性差的限制。对于这些EX/RP耐药患者，EX/RP结局较差。动机访谈（MI）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干预已成功用于酒精滥用和其他疾病，以增加治疗的进入、保留和依从性，并提高耐药患者的结局。然而，MI还没有系统地研究EX/RP耐药的强迫症患者。这项探索性研究资助（R34）的目标是开发和测试EX/RP+MI干预措施，旨在增加EX/RP耐药OCD患者的EX/RP进入，保留和依从性。作为焦虑症诊所（ADC）和焦虑治疗和研究中心（CTSA）之间的合作，该项目将建立在我们富有成效的十三年合作历史的基础上，从我们建立的合作基础设施中受益，并利用我们积累的专业知识与强迫症患者。如果在标准EX/RP治疗中增加短暂的MI干预可以显著改善本文提出的开放试验中EX/RP耐药患者的结局，则这些数据将用于支持更大规模的对照试验，以确认EX/RP+MI的疗效。如果EX/RP+MI干预是有效的，它可能会通过将EX/RP的已证实的力量带给更多的强迫症患者而对公共健康产生重大影响。这项探索性研究资助（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），用于EX/RP耐药的OCD患者（即，拒绝、退出或部分坚持先前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EX/RP+MI手册。2)探讨这种新型EX/RP+MI干预在改善EX/RP耐药OCD患者的OCD结局方面的疗效。在第2年和第3年，我们将在24名对既往EX/RP治疗反应较差的EX/RP耐药OCD门诊患者中进行一项EX/RP+MI干预的开放试验。

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.