A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder

Abstract

Objective: Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions.

Design: We conducted a randomized waitlist-controlled trial. n = 43 participants were randomly assigned to either DM or CR. Out of those participants, n = 21 participants had been previously assigned to a two-week waitlist condition.

Materials and methods: In both conditions, treatment comprised four double sessions within two weeks. Assessment took place at baseline (Pre1), after treatment (Post) and four weeks after the end of treatment (FU). There was a second baseline assessment (Pre2) in the waitlist group. Independent evaluators were blinded concerning the active condition. Adherence and competence ratings for the two therapists were obtained from an independent rater.

Results: 40 patients completed the treatment. Two patients dropped out because of exacerbated depression. There were no further adverse events. Both CR and DM were shown to be superior to waitlist and equally effective at reducing OCD symptoms from pre to post assessment as measured with the Y-BOCS (CR: d = 1.67, DM: d = 1.55). In each of the two treatment conditions, eight patients (40%) exhibited a clinical significant change at post assessment.

Conclusions: The results of this clinical trial suggest the potential efficacy of DM as a stand-alone intervention for OCD, however, our findings need to be interpreted with caution. Results indicate that both CR and DM should be considered as possible alternative treatments for OCD, whereas the working mechanisms of DM have yet to be elucidated.

Fig 1. CONSORT flowchart describing the study process and participant flow.

The reasons for exclusion after Pre1 assessment were as follows: OCD at subclinical level (n = 5), other than OCD being the primary diagnosis (n = 2), therapy focusing on OCD within the past 12 months (n = 2), history of psychosis (n = 1), recent change of medication (n = 1), acute Borderline Personality Disorder (n = 1), declined because experienced study protocol as too stressful (n = 1). Abbreviations: CR = cognitive restructuring, DM = detached mindfulness.

Fig 2. Line graph showing the results of the mixed ANOVA with 95% confidence intervals.

The upper graph visualizes the results from the non-waitlist group of completers (total n = 20; CR: n = 11; DM: n = 9), whereas the lower graph displays the results from the waitlist group of completers (total n = 20; CR: n = 9; DM: n = 11). In both graphs, T1 refers to the Pre1 assessment. In the upper graph, T2 refers to the Post assessment, whereas in the lower graph, T2 refers to the Pre2 assessment, thus separating the effects of time and treatment. Abbreviations: CR = cognitive restructuring, DM = detached mindfulness.