"Association splitting" versus cognitive remediation in obsessive-compulsive disorder: A randomized controlled trial

Area of Science:

• Psychiatry
• Clinical Psychology
• Cognitive Neuroscience

Background:

• Cognitive intervention Association Splitting (AS) is effective for obsessive-compulsive disorder (OCD) as a self-help technique.
• AS targets maladaptive cognitive networks in OCD by forming new neutral associations.
• Therapist-assisted AS as an adjunct to cognitive behavioral therapy (CBT) requires investigation.

Purpose of the Study:

• To evaluate the acceptance and benefits of therapist-assisted AS.
• To compare AS with cognitive remediation (CR) as an add-on to CBT for OCD patients.
• To assess the impact on overall symptom severity and specific symptom domains.

Main Methods:

• 109 OCD patients undergoing CBT were randomized to AS or CR.
• Assessments included the Yale-Brown Obsessive Compulsive Scale at baseline, 4 weeks, and 6 months.
• Primary outcome was overall symptom severity; secondary outcomes included avoidance.

Main Results:

• Patient acceptance of AS was favorable.
• AS did not demonstrate superiority over CR in reducing overall OCD symptom severity.
• A significant reduction in avoidance was observed in the AS group from baseline to 6 months.
• Post hoc analyses suggested AS superiority when potential "contagion effects" were excluded.

Conclusions:

• Therapist-assisted AS is well-accepted by OCD patients undergoing CBT.
• While not superior to CR for overall symptom severity, AS shows promise in reducing avoidance behaviors.
• Further research is needed to understand the efficacy of AS, considering potential confounding factors like information contagion.