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Cognitive behavioral therapy in patients with deep brain stimulation for obsessive-compulsive disorder: a matched controlled study

Published online by Cambridge University Press:  04 November 2022

Ilse Graat Open the ORCID record for Ilse Graat [Opens in a new window] ,
Sophie Franken ,
Geeske van Rooijen ,
Pelle de Koning ,
Nienke Vulink ,
Mirjam de Kroo ,
Damiaan Denys  and
Roel Mocking
Ilse Graat*
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Sophie Franken
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Geeske van Rooijen
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Pelle de Koning
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Nienke Vulink
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Mirjam de Kroo
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Damiaan Denys
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
Roel Mocking
Affiliation:
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
*
Author for correspondence: Ilse Graat, E-mail: i.graat@amsterdamumc.nl
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Abstract

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.

Keywords

Cognitive behavioral therapydeep brain stimulationobsessive-compulsive disorderprecision medicine
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 12 , September 2023 , pp. 5861 - 5867
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

Contributed equally.

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