Elsner Björn, Wolfsberger Frieder, Srp Jessica, Windsheimer Antonia, Becker Laura, Jacobi Tanja, Kathmann Norbert, Reuter Benedikt
Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
Clin Psychol Eur. 2020 Mar 31;2(1):e2785. doi: 10.32872/cpe.v2i1.2785. eCollection 2020 Mar.
Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and may afford stable long-term improvements. It is not clear, however, how stability or symptom recurrence can be predicted at the time of termination of CBT.
In a 1-year follow-up intention-to-treat study with 120 OCD patients receiving individual CBT at a university outpatient unit, we investigated the predictive value of international consensus criteria for response only (Y-BOCS score reduction by at least 35%) and remission status (Y-BOCS score ≤ 12). Secondly, we applied receiver-operating characteristic (ROC) curves in order to find an optimal cut-off score to classify for deterioration and for sustained gains.
Response only at post-treatment increased the likelihood of deterioration at follow-up compared to remission at an odds ratio of 8.8. Moreover, ROC curves indicated that a post-treatment score of ≥ 13 differentiated optimally between patients with and without symptom deterioration at follow-up assessment. The optimal cut-off score to classify for any sustained gains (response, remission, or both) at follow-up relative to baseline was 12. Importantly, previous findings of generally high long-term symptom stability after treatment in OCD could be replicated.
The findings highlight the clinical importance of reaching remission during CBT, and suggest that a recently published expert consensus for defining remission has high utility.
认知行为疗法（CBT）是治疗强迫症（OCD）的一种有效方法，可能带来稳定的长期改善。然而，目前尚不清楚在CBT治疗结束时如何预测症状的稳定性或复发情况。
在一项针对120名在大学门诊接受个体CBT治疗的强迫症患者的为期1年的意向性随访研究中，我们调查了仅依据反应（Y-BOCS评分降低至少35%）和缓解状态（Y-BOCS评分≤12）的国际共识标准的预测价值。其次，我们应用了受试者工作特征（ROC）曲线，以找到一个最佳分界分数来对病情恶化和持续改善进行分类。
与缓解相比，仅在治疗后有反应会使随访时病情恶化的可能性增加，优势比为8.8。此外，ROC曲线表明，治疗后评分为≥13可在随访评估时对有症状恶化和无症状恶化的患者进行最佳区分。相对于基线，用于对随访时任何持续改善（反应、缓解或两者兼有）进行分类的最佳分界分数为12。重要的是，此前关于强迫症治疗后长期症状普遍具有高稳定性的研究结果能够得到重复验证。
这些发现突出了在CBT治疗期间实现缓解的临床重要性，并表明最近发表的关于定义缓解的专家共识具有很高的实用性。
