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      A pilot randomized controlled trial of time-intensive cognitive–behaviour therapy for postpartum obsessive–compulsive disorder: effects on maternal symptoms, mother–infant interactions and attachment

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          Abstract

          Background

          There is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive–compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting.

          Method

          A total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive–behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother–infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants ( n = 37) underwent the same assessments as a benchmark.

          Results

          iCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31–1.90). However, mother–infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group.

          Conclusions

          iCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.

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          Most cited references41

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          Quality of life in the anxiety disorders: a meta-analytic review.

          There has been significant interest in the impact of anxiety disorders on quality of life. In this meta-analytic review, we empirically evaluate differences in quality of life between patients with anxiety disorders and nonclinical controls. Thirty-two patient samples from 23 separate studies (N=2892) were included in the analysis. The results yielded a large effect size indicating poorer quality of life among anxiety disorder patients vs. controls and this effect was observed across all anxiety disorders. Compared to control samples, no anxiety disorder diagnosis was associated with significantly poorer overall quality of life than was any other anxiety disorder diagnosis. Examination of specific domains of QOL suggests that impairments may be particularly prominent among patients with post-traumatic stress disorder. QOL domains of mental health and social functioning were associated with the highest levels of impairment among anxiety disorder patients. These findings are discussed in the context of future research on the assessment of quality of life in the anxiety disorders.
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            The Structured Clinical Interview for DSM-III-R (SCID)

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              Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014.

              Obsessive-compulsive disorder is ranked by the WHO as among the 10 most debilitating disorders and tends to be chronic without adequate treatment. The only psychological treatment that has been found effective is cognitive behavior therapy (CBT). This meta-analysis includes all RCTs (N=37) of CBT for OCD using the interview-based Yale-Brown Obsessive Compulsive Scale, published 1993 to 2014. The effect sizes for comparisons of CBT with waiting-list (1.31), and placebo conditions (1.33) were very large, whereas those for comparisons between individual and group treatment (0.17), and exposure and response prevention vs. cognitive therapy (0.07) were small and non-significant. CBT was significantly better than antidepressant medication (0.55), but the combination of CBT and medication was not significantly better than CBT plus placebo (0.25). The RCTs have a number of methodological problems and recommendations for improving the methodological rigor are discussed as well as clinical implications of the findings.
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                Author and article information

                Journal
                Psychological Medicine
                Psychol. Med.
                Cambridge University Press (CUP)
                0033-2917
                1469-8978
                June 2017
                January 31 2017
                June 2017
                : 47
                : 8
                : 1478-1488
                Article
                10.1017/S0033291716003573
                28137316
                3d91645e-6cbc-4f5c-8905-1e80bf3a6613
                © 2017

                https://www.cambridge.org/core/terms

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