Mindfulness-Based Cognitive Therapy: Efficacy and fMRI-based Response Predictors in a Group of OCD Patients

January 12, 2018 updated by: Clara López-Solà, Corporacion Parc Tauli

Mindfulness-Based Cognitive Therapy: Efficacy and fMRI-based Response Predictors in a Group of OCD Patients Non-responders to CBT

Obsessive-Compulsive Disorder (OCD) patients have a response rate of 50-60% to exposure and response prevention (ERP) therapy and SSRI antidepressants. Mindfulness-Based Cognitive Therapy (MBCT) consists of training the participant to non-react to negative thoughts and emotions. Applying MBCT to OCD patients may help them behave with equanimity in response to their obsessions, and therefore acknowledge them with the same attention and intention as they admit any other disturbing thought without reacting to it. MBCT has demonstrated effectiveness in major depression, but much less attention has been given to MBCT in OCD. ERP and MBCT, although sharing aspects like exposure, are based on different theoretic and therapeutic factors. EPR is based on a direct anxiety habituation process whereas MBCT trains a holistic manner of becoming familiarized with distressful thoughts and emotions while learning to develop a new relationship to them. Thus, MBCT may decrease anxiety indirectly through a major attention awareness and non-reactivity to thoughts and emotions.

OCD is characterized by altered cortical-striatal-thalamic-cortical (CSTC) circuit and default mode network (DMN) connectivity when performing different tasks and during the resting state. It has been establish that the ventral CSTC circuit is mostly associated with emotional processing, while the dorsolateral aspect of the CSTC circuit is preferentially involved in cognitive processing. In this regard, we hypothesized that clinical amelioration will be accompanied by a re-establishment of functional connectivity within dorsolateral and DMN circuits, which will in turn be associated with improvement of certain neuropsychological processes. CSTC and DMN circuits have also shown to be sensitive to prolonged stress situations. Specifically, childhood trauma has been related to larger brain volumes and it has been associated with different OCD clinical subtypes.

Aims: 1. To assess MBCT effectiveness in treatment non-naive OCD patients. 2. To study cognitive and neuropsychological characteristics that mediate or moderate MBCT response. 3. To examine the changes in cognitive, neuropsychological and neuroimaging patterns associated with an MBCT intervention. 4. To identify a brain biomarker for positive response to MBCT in non-naïve OCD patients. 5. To study cognitive, neuropsychological and early stress expousure mediators or moderators of functional changes in CSTC and DMN patterns in response to MBCT.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
    • Barcelona
      • Sabadell, Barcelona, Spain, 08001

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 50 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age frame: 18-50 years old.
  • Principal Diagnosis: Obsessive compulsive disorder.
  • Severity of OCD symptoms: between mild (Y-BOCS=9) and severe (Y-BOCS=32)
  • Previous structured CBT or EPR, either in group or individual format, between 10 to 20 sessions.
  • A maximum of three different pharmacological strategies.
  • Minimum of IQ 85 measured by Vocabulary subtest (WAIS-IV).
  • Minimum level of schooling: 14 years.
  • To sign the informant consent.

Exclusion Criteria:

  • Organic pathology and/or neurological disorders such as brain injury or epilepsy.
  • Comorbidity with: Mental Retardation, previous or current substance abuse, psychotic disorders, bipolar disorder. Other affective and/or anxiety disorders will not be an exclusion criteria if OCD is considered the primary diagnosis.
  • Recent suicide attempt/active suicidality
  • Previous completion of an MBCT course (≥ 8 weeks)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Sequential Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Mindfulness Based Intervention

Mindfulness-based cognitive therapy (MBCT), adjusted to OCD patients, will be applied in 10 weekly sessions of 2 hours followed by an extra session 4 weeks later. The treatment will be applied in a group format of 10 to 12 patients.

These patients will be also attending to their regular psychiatric visits for medication control.
Behavioral: Mindfulness Based Intervention
The mindfulness based intervention protocol used in this project is adapted from the original and validated MBCT program for depression (Segal, Williams & Teasdale, 2002). Two more sessions, focused on obsessive symptoms specfic to each participant, will be included. Those two sessions will be adapted from the manual "The Mindfulness Workbook for OCD" (Hershfield and Corboy, 2013).
Other Names:
  • MBCT
Drug: Treatment as Usual
The psychiatric referee will follow OCD guidelines modifying or potentiating drug treatments if needed.
Other Names:
  • TAU
Active Comparator: Treatment as Usual (TAU)
Patients will be attending to their regular psychiatric visits during the whole trial period.
Drug: Treatment as Usual
The psychiatric referee will follow OCD guidelines modifying or potentiating drug treatments if needed.
Other Names:
  • TAU

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Y-BOCS:
Time Frame: Baseline and at 14 weeks and at 6 months post-treatment
• Clinical version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) the severity and the checklist.
Baseline and at 14 weeks and at 6 months post-treatment
Change in OCI-R:
Time Frame: Baseline, at 14 weeks and at 6 months post-treatment
• Obsessive-Compulsive Inventory-Revised (OCI-R) assessing 6 dimensions (Washing, Checking, Ordering, Obsessing, Hoarding and Neutralizing).
Baseline, at 14 weeks and at 6 months post-treatment
Change in OBQ-44:
Time Frame: Baseline and at 14 weeks
• Obsessive Beliefs Questionnaire-44 (OBQ-44), a measure of three OCD-related belief domains (Perfectionism/Certainty, Importance/Control of thoughts, and Responsibility/Threat estimation).
Baseline and at 14 weeks
Changes in functional brain circuits:
Time Frame: Baseline and at 14 weeks
• Functional Magnetic Resonance Imaging: Resting state and during task performance (Autobiographical memory + N-Back) and self-reference.
Baseline and at 14 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in anxiety:
Time Frame: Baseline and at 14 weeks
• Anxiety Sensitivity Index (ASI-3)
Baseline and at 14 weeks
Change in mood from baseline:
Time Frame: Baseline, at 14 weeks and at 6 months post-treatment
• The Beck Depression Inventory (BDI-II)
Baseline, at 14 weeks and at 6 months post-treatment
Change in positive and negative affect:
Time Frame: Baseline and at 14 weeks
• Positive and Negative Affect trait (PANAS)
Baseline and at 14 weeks
Impact of current life events:
Time Frame: Baseline, 14 weeks and at 6 months post-treatment
• Perceived Stress Scale (PSS)
Baseline, 14 weeks and at 6 months post-treatment
Impact of past stressful life events:
Time Frame: Baseline
• Childhood Trauma Questionnaire (CTQ)
Baseline
Change in attentional domains:
Time Frame: Baseline and at 14 weeks
• Conners' Continuous Performance Test II : CPT-II
Baseline and at 14 weeks
Change in executive Functioning/Cognitive flexibility:
Time Frame: Baseline and at 14 weeks
• Wisconsin Card Sorting Test: WCST
Baseline and at 14 weeks
Autobiographical memories:
Time Frame: Baseline
• Autobiographic Memory Task: 10 selected emotions (5 negative and 5 positive).
Baseline
Change in verbal fluency:
Time Frame: Baseline, 14 weeks and at 6 months post-treatment
• Phonetic Fluency: PMR (Spanish version of the FAS)
Baseline, 14 weeks and at 6 months post-treatment
Speech analysis:
Time Frame: Baseline
• Word Task: Assessment of language fluency and thought content using a list of 10 seed words from the Spanish adaptation of the ANEW (Affective Norms for English Words) in terms of positive and negative valance and different degrees of arousal.
Baseline
Thought content:
Time Frame: Baseline, each week during the treatment period (10 sessions) and post-treatment
• ES-Questionnaire, designed by Drs. J. Andrews-Hanna and M. López-Solà (research collaborators of the project) from the USA. It is based on 23 questions that examines the thought content from the patient before, during and after the treatment.
Baseline, each week during the treatment period (10 sessions) and post-treatment
Change in Quality of Life:
Time Frame: Baseline, 14 weeks and at 6 months post-treatment
• Multicultural Quality of Life Index (MQLI).
Baseline, 14 weeks and at 6 months post-treatment
Change in Mindfulness variables:
Time Frame: Baseline, 14 weeks and at 6 months post-treatment
• Mindfulness measures include: The Five Facet Mindfulness Questionnaire (FFMQ), used to measure the five constructs central to mindfulness (Observing, Describing, Acting with Awareness, Non-judgment of Inner Experience, and Non-reactivity to Inner Experience).
Baseline, 14 weeks and at 6 months post-treatment
Change in Rumination:
Time Frame: Baseline, 14 weeks and at 6 months post-treatment
• Ruminative Responses Scale (RRS) to measure the degree and type of thought thinking.
Baseline, 14 weeks and at 6 months post-treatment
Treatment expectancy:
Time Frame: Baseline
• Credibility Expectancy Questionnaire (CEQ).
Baseline
Changes in structural brain regions:
Time Frame: Baseline and at 14 weeks
• Structural acquisition: T13D
Baseline and at 14 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Corporacion Parc Tauli

Collaborators

Children's Hospital Medical Center, Cincinnati
University of Arizona
Hospital Universitari de Bellvitge

Investigators

  • Principal Investigator: Clara López-Solà, PhD, Corporació Parc Tauli
  • Principal Investigator: Maria Serra-Blasco, PhD, Fundacio Parc Tauli
  • Principal Investigator: Pino Alonso, MD, PhD, Bellvitge University Hospital
  • Principal Investigator: Jessica Andrews-Hanna, PhD, University of Arizona

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 11, 2018

Primary Completion (Anticipated)

December 1, 2018

Study Completion (Anticipated)

December 1, 2018

Study Registration Dates

First Submitted

April 7, 2017

First Submitted That Met QC Criteria

April 24, 2017

First Posted (Actual)

April 25, 2017

Study Record Updates

Last Update Posted (Actual)

January 17, 2018

Last Update Submitted That Met QC Criteria

January 12, 2018

Last Verified

January 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CorporacionPT CIR2016/030

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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