TY - JOUR
T1 - Cognitive behavioral therapy in patients with deep brain stimulation for obsessive-compulsive disorder
T2 - a matched controlled study
AU - Graat, Ilse
AU - Franken, Sophie
AU - van Rooijen, Geeske
AU - de Koning, Pelle
AU - Vulink, Nienke
AU - de Kroo, Mirjam
AU - Denys, Damiaan
AU - Mocking, Roel
N1 - Funding Information: R.T. Mocking is funded by unrestricted ABC Talent Grants. D. Denys has received funding from ZonMw (no. 636310016) and Boston Scientific (in kind) for a trial on deep brain stimulation for depression. No funding was received for the present trial. Publisher Copyright: © The Author(s), 2022. Published by Cambridge University Press.
PY - 2023/9/4
Y1 - 2023/9/4
N2 - Background. Deep brain stimulation (DBS) is effective for refractory obsessive-compulsive disorder (OCD). Post-operative cognitive behavioral therapy (CBT) may augment the effects of DBS, but previous results are conflicting. Here, we investigated whether CBT augments the effect of DBS for OCD. Method. Patients with and without CBT following DBS of the ventral anterior limb of the internal capsule were included. First, we analyzed Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores before, during and after CBT in all patients with CBT. Second, we matched patients with and without CBT based on clinical baseline variables and initial response to DBS and compared the course of Y-BOCS and HAM-D scores over the same timeframe. Results. In total, 36 patients with and 16 patients without CBT were included. Average duration of CBT was 10.4 months (S.D. 6.4). In the 36 patients with CBT, Y-BOCS scores decreased on average by 3.8 points (14.8%) from start until end of CBT (p = 0.043). HAM-D scores did not decrease following CBT. Second, 10 patients with CBT were matched to 10 patients without CBT. In both groups, Y-BOCS scores decreased equally from start until end of CBT or over a similar timeframe (10% in CBT group v. 13.1% in no-CBT group, p = 0.741). Conclusions. Obsessive-compulsive symptoms decreased over time in patients with and without post-operative CBT. Therefore, further improvement may be attributed to late effects of DBS itself. The present study emphasizes the need for prospective randomized controlled studies, examining the effects of CBT.
AB - Background. Deep brain stimulation (DBS) is effective for refractory obsessive-compulsive disorder (OCD). Post-operative cognitive behavioral therapy (CBT) may augment the effects of DBS, but previous results are conflicting. Here, we investigated whether CBT augments the effect of DBS for OCD. Method. Patients with and without CBT following DBS of the ventral anterior limb of the internal capsule were included. First, we analyzed Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores before, during and after CBT in all patients with CBT. Second, we matched patients with and without CBT based on clinical baseline variables and initial response to DBS and compared the course of Y-BOCS and HAM-D scores over the same timeframe. Results. In total, 36 patients with and 16 patients without CBT were included. Average duration of CBT was 10.4 months (S.D. 6.4). In the 36 patients with CBT, Y-BOCS scores decreased on average by 3.8 points (14.8%) from start until end of CBT (p = 0.043). HAM-D scores did not decrease following CBT. Second, 10 patients with CBT were matched to 10 patients without CBT. In both groups, Y-BOCS scores decreased equally from start until end of CBT or over a similar timeframe (10% in CBT group v. 13.1% in no-CBT group, p = 0.741). Conclusions. Obsessive-compulsive symptoms decreased over time in patients with and without post-operative CBT. Therefore, further improvement may be attributed to late effects of DBS itself. The present study emphasizes the need for prospective randomized controlled studies, examining the effects of CBT.
KW - Cognitive behavioral therapy
KW - deep brain stimulation
KW - obsessive-compulsive disorder
KW - precision medicine
UR - http://www.scopus.com/inward/record.url?scp=85171685604&partnerID=8YFLogxK
U2 - https://doi.org/10.1017/S0033291722003130
DO - https://doi.org/10.1017/S0033291722003130
M3 - Article
C2 - 37795687
SN - 0033-2917
VL - 53
SP - 5861
EP - 5867
JO - Psychological Medicine
JF - Psychological Medicine
IS - 12
ER -