Comparing two psychological treatments for the management of primarily obsessional OCD

INTERVENTION: 70 patients with a diagnosis of predominantly obsessional OCD were recruited from inpatient or outpatient departments of NIMHANS. They were randomly allocated into two groups – Mindfulness Integrated Cognitive Therapy (MICT) (n = 35) or Cognitive Behavior therapy (CBT) group (n = 35), based on a computer‐generated random table. Seventy chits were prepared and the respective group’s name was written in each chit. For each patient, the respective number chit was opened by the therapist after recruitment and baseline assessments were completed. A two‐group randomized controlled design with baseline, post‐therapy and 3‐month follow‐up assessment was adopted. A sample size of n = 70 (35 in MICT and 35 in CBT group) was considered adequate to attain a two tailed significance of = 0.05 with 80% power to detect about 30% difference in response rate based on Yale–Brown Obsessive Compulsive Scale (Y‐BOCS) change between the groups. After the recruitment, informed consent forms were obtained from each patient. Then detailed intake and baseline assessments were administered. The blind rater administered Y‐BOCS and Clinical Global Impression (CGI) scale which were primary outcome measures. Thereafter, patients were randomly assigned to either MICT (n =35) or CBT group (n = 35). Patients were delivered 10 to 14 sessions of respective therapies (either MICT or CBT) following structured modules, which were spread over 6 to 8 weeks, and the duration of each session was 90 min. MICT modules: ‐ Session 1 – Psychoeducation • Assessing patient’s knowledge about OCD and appraisal of intrusive thoughts • Discussion on nature of obsessions, when an intrusive thoughts become clinically significant, using unhelpful strategies and their counterproductive result, significance given to intrusions etc. • Psychoeducating from mindfulness perspectives using metaphors CONDITION: Obsessive Compulsive Disorder (OCD) ‐ Predominantly Obsessive type ; Mental and Behavioural Disorders PRIMARY OUTCOME: ; 1. Severity, avoidance and insight of obsessive compulsive symptoms assessed using the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) at baseline, post‐intervention and 3 months follow‐up; 2. Severity of overall illness assessed using the Clinical Global Impression Scale (CGI) at baseline, post‐intervention and 3 months follow‐up; INCLUSION CRITERIA: 1. Patients with a primary diagnosis of OCD ‐ predominantly obsessions as per DSM 5 criteria 2. Few or no overt compulsions 3. Y‐BOCS score at baseline 10 or more 4. CGI – severity criteria – moderately ill 5. Aged between 18 and 55 years 6. Minimum education of class X 7. Patients fluent in Bengali, English or Hindi with ability to comprehend English text in assessment tools 8. Patients who are either drug‐naïve, drug‐free or stabilized on medication for 2 months prior to the entry to the study SECONDARY OUTCOME: ; 1. Depression, anxiety and stress assessed using the Depression Anxiety Stress Scale (DASS‐21) at baseline, post‐intervention and 3 months follow‐up; 2. Dysfunctional beliefs assessed using the Obsessive Belief Questionnaire (OBQ‐21) at baseline, post‐intervention and 3 months follow‐up; 3. Mindfulness skills assessed using the Five facet Mindfulness Questionnaire (FFMQ) at baseline, post‐intervention and 3 months follow‐up; 4. Experiential avoidance assessed using the Acceptance and Action Questionnaire (AAQ‐II) at baseline, post‐intervention and 3 months follow‐up; 5. Overall quality of life assessed using the World Health Organization Quality of Life (WHOQOL‐BREF) questionnaire at baseline, post‐intervention and 3 months follow‐up; 6. Social and functional impairment assessed using the Work and Social Adjustment Scale (WSAS) at baseline, post‐intervention and 3 months follow‐up; 7. Degree and quality of homework assessed using the Homework Compliance Scale at post intervention and 3‐months follow‐up;