Investigating the effect of adding neurofeedback to the choice treatment (cognitive behavioral therapy and medication) on obsessive beliefs and early maladaptive schemas in patients with obsessive-compulsive disorder

Document Type : Research Paper

Authors

1 Associate professor of clinical psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Neurology and Psychiatry, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran.

3 MSc. in clinical psychology, Faculty of Psychology and Education Science, Ferdowsi University of Mashhad, Mashhad, Iran.

4 MSc. in clinical psychology, Department of Clinical Psychology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: This study aimed to investigate the effects of adding Neurofeedback Therapy (NFT) to taking medication (Selective Serotonin Reuptake Inhibitors: SSRIs) and Cognitive Behavioral Therapy (CBT) in patients with Obsessive-Compulsive Disorder (OCD) on Obsessive Beliefs (OBs) and Early Maladaptive Schemas (EMSs).
 
Materials and Methods: In this clinical trial conducted in Mashhad, Iran in 2019, 10 diagnosed OCD patients were selected using purposeful sampling. They were randomly assigned into equal two groups (group 1: NFT + SSRIs + CBT, group 2: SSRIs + CBT). They were evaluated using the Obsessive Beliefs Questionnaire (OBQ) and Young Schema Questionnaire-Short Form (YSQ) before intervention, on the 8th session, after treatment, and a two-month follow-up. Repeated-measures ANOVA tests were used for statistical analysis.
 
Results: There was a significant time × intervention effect for all fifteen EMSs (P< 0.05) and three OBs (P< 0.05); however, significant time × condition interaction has been seen for responsibility/threat estimation belief (P< 0.05) and abandonment, defectiveness/shame, enmeshment/undeveloped self, insufficient self-control/self-discipline, mistrust/abuse, subjugation, and social isolation/alienation, and unrelenting standards schemas (P< 0.05). We found no significant difference between treatment groups in EMSs and OBs.
 
Conclusion: The results showed that both treatment plans are effective in the reduction of obsessive beliefs and early maladaptive schemas; however, adding neurofeedback to standard therapy has not resulted in significant differences in reducing obsessive beliefs and early maladaptive schemas in patients with obsessive-compulsive disorder.

Keywords

References

  1. Sachs G, Erfurth A. Obsessive compulsive and related disorders: From the biological basis to a rational pharmacological treatment. Int J Neuropsychopharmacol 2018; 21(1): 59-62.
  2. Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: A meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry 2020; 81(4): 19r13085.
  3. Oudheusden LJB, Schoot R, Hoogendoorn A, Oppen P, Kaarsemaker M, Meynen G, et al. Classification of comorbidity in obsessive-compulsive disorder: A latent class analysis. Brain Behav 2020; 10(7): e01641.
  4. Abramowitz JS. Presidential address: are the obsessive-compulsive related disorders related to obsessive-compulsive disorder? A critical look at DSM-5’s new category. Behav Ther 2018; 49(1): 1-11.
  5. Bruin W, Denys D, van Wingen G. Diagnostic neuroimaging markers of obsessive-compulsive disorder: initial evidence from structural and functional MRI studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91: 49-59.
  6. Reuther ET, Davis III TE, Rudy BM, Jenkins WS, Whiting SE, May AC. Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive‐compulsive symptom severity. Depress Anxiety 2013; 30(8): 773-7.
  7. Group OCCW. Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory—Part 2: Factor analyses and testing of a brief version. Behav Res Ther 2005; 43(11): 1527-42.
  8. Hellberg SN, Buchholz JL, Twohig MP, Abramowitz JS. Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clin Psychol Psychother 2020; 27(1): 69-78.
  9. Sunde T, Hummelen B, Himle JA, Walseth LT, Vogel PA, Launes G, et al. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2019; 19(1): 318.
  10. Basile B, Tenore K, Luppino OI, Mancini F. Schema therapy mode model applied to OCD. Clinical Neuropsychiatry 2017; 14(6): 407-14.
  11. Shariatzadeh M. Prediction of obsessive-compulsive disorder symptoms via early maladaptive schemas. International journal of innovation and research in educational sciences 2017; 4(3): 265-70.
  12. Kizilagac F, Cerit C. [Assessment of early maladaptive schemas in patients with obsessive-compulsive disorder]. Dusunen Adam 2019; 32(1): 14. (Turkish)
  13. Mashhadi ND, Shirkhani M, Mahdavian M, Mahmoudi S. Predicting the severity of obsessive-compulsive syndrome based on perceived parenting style: The mediating role of obsessive beliefs. Journal of fundamentals of mental health 2022; 24(1): 29-37.
  14. Albert U, Di Salvo G, Solia F, Rosso G, Maina G. Combining drug and psychological treatments for Obsessive-Compulsive Disorder: what is the evidence, when and for whom. Curr Med Chem 2018; 25(41): 5632-46.
  15. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry 2006; 51(7): 407-16.
  16. Vyskocilova J, Stuchlikova L, Kotianova A, Slepecky M, Prasko J. Group CBT for patients with obsessive compulsive disorder–predictors of therapeutic efficacy. Eur Psychiatry 2015; 30: 1496.
  17. Johnco C, McGuire JF, Roper T, Storch EA. A meta‐analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. Depress Anxiety 2019; 37(5): 407-17.
  18. Højgaard DR, Schneider SC, La Buissonnière-Ariza V, Kay B, Riemann BC, Jacobi D, et al. Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD). Cogn Behav Ther 2020; 49(4): 294-306.
  19. Wilhelm S, Berman NC, Keshaviah A, Schwartz RA, Steketee G. Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behav Res Ther 2015; 65: 5-10.
  20. Haaland AT, Vogel PA, Launes G, Haaland VØ, Hansen B, Solem S, et al. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 2011; 49(11): 781-8.
  21. Ferreri F, Bourla A, Peretti C-S, Segawa T, Jaafari N, Mouchabac S. How new technologies can improve prediction, assessment, and intervention in obsessive-compulsive disorder (e-OCD). JMIR Ment Health 2019; 6(12): e11643.
  22. Shahmoradi S, Oraky M. The effect of neuro-feedback on indicators obsessive-compulsive disorder and anxiety. Neuroquantology 2019; 17(7): 1-17.
  23. Hampson M, Stoica T, Saksa J, Scheinost D, Qiu M, Bhawnani J, et al. Real-time fMRI biofeedback targeting the orbitofrontal cortex for contamination anxiety. J Vis Exp 2012; 59: 3535.
  24. Ferreira S, Pego JM, Morgado P. The efficacy of biofeedback approaches for obsessive-compulsive and related disorders: A systematic review and meta-analysis. Psychiatry Res 2019; 272: 237-45.
  25. Masjedi Arani A, Asgharipour N, Banihashem S, Saberi Isfeedvajani M, Dorri Mashhadi N. A comparison of the effectiveness of adding neurofeedback to standard treatment (SSRIs + CBT) in patients with Obsessive-Compulsive Disorder (OCD). J Appl Environ Biol Sci 2019; 9(5): 11-19.
  26. Bandelow B, Sher L, Bunevicius R, Hollander E, Kasper S, Zohar J, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract 2012; 16(2): 77-84.
  27. Foa EB. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci 2010; 12(2): 199.
  28. Hammond DC. Neurofeedback with anxiety and affective disorders. Child Adolesc Psychiatr Clin N Am 2005; 14(1): 105-23.
  29. Sürmeli T, Ertem A. Obsessive compulsive disorder and the efficacy of qEEG-guided neurofeedback treatment: A case series. Clin EEG Neurosci 2011; 42(3): 195-201.
  30. Lobbestael J, Leurgans M, Arntz A. Inter‐rater reliability of the Structured Clinical Interview for DSM‐IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clin Psychol Psychother 2011; 18(1): 75-9.
  31. Sharifi V, Asadi S, Mohammadi M, Amini H, Kaviani H, Semnani Y, et al. [Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID)]. Advances in cognitive science 2004; 6(1-2): 10-22. (Persian)
  32. Shams G, Karam Ghadiri N, Esmaeli Torkanbori Y, Ebrahimkhani N. [Validity and reliability of the Persian version of the Obsessive Beliefs Questionnaire]. Advances in cognitive sciences 2004; 6(1-2): 23-36. (Persian)
  33. Welburn K, Coristine M, Dagg P, Pontefract A, Jordan S. The Schema Questionnaire—Short Form: Factor analysis and relationship between schemas and symptoms. Cognit Ther Res 2002; 26(4): 519-30.
  34. Yalcin O, Marais I, Lee CW, Correia H. The YSQ-R: Predictive validity and comparison to the short and long form young schema questionnaire. Int J Environ Res Public Health 2023; 20(3): 1778.
  35. Ghahari S, Viesy F, Kavand H, Fallah M, Zandifar H, Farrokhi N, et al. [Psychometric properties of Early Maladaptive Schemas Questionnaire Short Form-75 Items (YSQ-SF)]. Nurse and physician within war 2020; 8: 31-40. (Persian)
  36. Diedrich A, Sckopke P, Schwartz C, Schlegl S, Osen B, Stierle C, et al. Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder–a process-outcome study. BMC Psychiatry 2016; 16(1): 220.
  37. Toroslu B, Çırakoğlu OC. Do perfectionism and intolerance of uncertainty mediate the relationship between early maladaptive schemas and relationship and partner related obsessive–compulsive symptoms? Current psychology 2023; 42: 19037-53.
  38. Surmeli T, Eralp E, Mustafazade I, Kos IH, Özer GE, Surmeli OH. Quantitative EEG neurometric analysis–guided neurofeedback treatment in Postconcussion Syndrome (PCS): Forty cases. How is neurometric analysis important for the treatment of PCS and as a biomarker? Clin EEG Neurosci 2017; 48(3): 217-30.
  39. Magda Z, Pelc M. Using neurofeedback as an alternative for drug therapy in selected mental disorders. Biomedical engineering and neuroscience. Proceedings of the 3rd International Scientific Conference on Brain-Computer Interfaces, BCI 2018, March 13-14, Opole, Poland.
  40. Rance M, Zhao Z, Zaboski B, Kichuk SA, Romaker E, Koller WN, et al. Neurofeedback for obsessive compulsive disorder: A randomized, double-blind trial. Psychiatry Res 2023; 328: 115458.
Journal of Fundamentals of Mental Health
Volume 26, Issue 1
January and February 2024
Pages 17-25

Files

Share

How to cite

Statistics