Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design

Abstract

Obsessive–compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.

A preliminary investigation of the mediating roles of self‐compassion and emotion dysregulation in the relationship between maladaptive perfectionism and obsessive‐compulsive behaviors

“…Given the possible enduring nature of perfectionism (see Handley et al, 2015), that self‐compassion and emotion regulation, both considered largely malleable (Koole, 2009; Neff, 2003), may influence the trajectory of OC symptoms represent a unique opportunity for OCD sufferers and the clinicians who treat them. Indeed, integrating these skills with standard ERP may enhance treatment response by addressing factors key to the development and maintenance of the disorder, thereby mitigating attrition, increasing therapy tolerance and acceptability, and improving residual symptoms (Allen & Barlow, 2009; Berking et al, 2008; Petrocchi et al, 2021). For example, future studies could explore the efficacy of enhanced ERP models, augmented with skills training drawing on strategies from compassion‐focused therapy (Gilbert, 2014) and affect regulation training (Berking & Whitley, 2014), compared with standard ERP.…”

The power of compassion in group psycotherapy

“…Although the group experience outlined in our vignette helped Marianna and Brian improve significantly, clients who have particularly high levels of self‐criticism and a persistent unwillingness to address fears, blocks, and resistances are less likely to experience such positive outcomes. Furthermore, although there is significant literature indicating that infusing compassion‐focused approaches to various types of group work is indeed effective for a number of presenting concerns across numerous settings (e.g., see Braehler et al, 2013; Clapton et al, 2018; Gilbert & Procter, 2006; Fox et al, 2021; Kirby et al, 2019; Laithwaite et al, 2009; Naismith et al, 2020; Petrocchi et al, 2021), further research will help solidify who benefits most from the CFT group psychotherapy and how to adapt this approach for those group members who have less favorable outcomes (Griner et al, 2022).…”

The association between OCD and Shame: A systematic review and meta‐analysis

“…A recent pilot study conducted by Petrocchi et al ( 2021 ) evaluated the tolerability and effectiveness of an 8‐week CFT program to decrease OCD symptoms and accompanying concerns such as fear of guilt and self‐criticism with a small sample ( n = 8) of OCD patients who had completed a minimum of 6 months CBT treatment prior with little improvement. Participants reported a decrease in OCD symptoms, fear of guilt and self‐criticism and satisfaction with the treatment.…”