Neurobiological Mechanisms of Metacognitive Therapy – An Experimental Paradigm

Winter, Lotta; Alam, Mesbah; Heissler, Hans E.; Saryyeva, Assel; Milakara, Denny; Jin, Xingxing; Heitland, Ivo; Schwabe, Kerstin; Krauss, Joachim K.; Kahl, Kai G.

doi:10.3389/fpsyg.2019.00660

Cited by 9 publications

(6 citation statements)

References 57 publications

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“…Deep brain stimulation (DBS) has emerged as a promising treatment option for patients with trOCD (9)(10)(11)(12). Common targets of DBS were summarized in recent reviews and include white matter trajectories (anterior limb of the internal capsule [ALIC], inferior thalamic peduncle, median forebrain bundle), and gray matter subcortical nuclei (nucleus accumbens, nucleus subthalamicus, bed nucleus of the stria terminalis [BNST]) (13)(14)(15). A guideline by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (16) came to the conclusion that there is level I evidence for bilateral subthalamic nucleus and level II evidence for bilateral nucleus accumbens DBS in trOCD (16).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up

Winter

Saryyeva

Schwabe

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Background Obsessive compulsive disorder (OCD) is a severe disabling disease, and around 10% of patients are considered to be treatment‐resistant (tr) in spite of guideline‐based therapy. Deep brain stimulation (DBS) has been proposed as a promising treatment for patients with trOCD. However, the optimal site for stimulation is still a matter of debate, and clinical long‐term follow‐up observations including data on quality of life are sparse. We here present six trOCD patients who underwent DBS with electrodes placed in the bed nucleus of the stria terminalis/anterior limb of the internal capsule (BNST/ALIC), followed for four to eight years after lead implantation. Materials and Methods In this prospective observational study, six patients (four men, two women) aged 32–51 years and suffering from severe to extreme trOCD underwent DBS of the BNST/ALIC. Symptom severity was assessed using the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS), and quality of life using the World Health Organization Quality of Life assessment scale (WHO‐QoL BREF). Follow‐up was obtained at least for four years in all patients. Results With chronic DBS for four to eight years, four of the six patients had sustained improvement. Two patients remitted and two patients responded (defined as >35% symptom reduction), while the other two patients were considered nonresponders on long‐term. Quality of life markedly improved in remitters and responders. We did not observe peri‐interventional side effects or adverse effects of chronic stimulation. Conclusions Chronic DBS of ALIC provides long‐term benefit up to four to eight years in trOCD, although not all patients take profit. Targeting the BNST was not particularly relevant since no patient appeared to benefit from direct stimulation of the BNST. Quality of life improved in DBS responders, documented by improved QoL scores and, even more important, by regaining of autonomy and improving psychosocial functioning.

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Section: Introductionmentioning

confidence: 99%

Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up

Winter

Saryyeva

Schwabe

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…Winter et al wondered about the neuronal base of the MCT and investigated the short-term effect of the MCT on neuronal local field potentials at baseline and after 5 sessions of the MCT treatment period by using bilateral electrodes in the patient who suffered from the implantation of deep brain stimulation. 36 They found that the symptoms of OCD reduced after 5 sessions of the MCT treatment, accompanying a reduction in the relative power of theta-band activity and an increase in alpha, beta, and gamma-band activity. Rupp et al 37 in another study examined the efficacy of the DM and cognitive restructuring as stand-alone interventions in patients with OCD.…”

Section: Resultsmentioning

confidence: 97%

Metacognitive Therapy in Patients with ObsessiveCompulsive Disorder: A review

Atmaca¹

2022

ALPHA PSYCHIATRY

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Metacognitive therapy is a relatively novel and growing psychotherapeutic approach. Within the last 20 years, several metacognitive-oriented therapy methods have been developed. They are metacognitive therapy which was developed by Wells, metacognitive training which was produced by Moritz et al. especially for patients with psychotic disorder, and metacognitive reflection and insight therapy for psychotic patients. Among them, the most structured one seems the metacognitive therapy. The main notion of metacognitive therapy is to alter the dysfunctional metacognitive interpretations and strategies underlying psychopathology. However, it should be emphasized that it has some fundamental differences from cognitive behavioral therapy because metacognitive therapy is a relatively new school of cognitive therapy, its effectiveness in the treatment of many psychiatric disorders continues to be evaluated intensively. Obsessive-compulsive disorder is one of these disorders. As obsessive-compulsive disorder is a lifelong disorder that causes significant loss of workforce and pharmacotherapy is sometimes insufficient, psychotherapeutic approaches are of great importance. In this context, exposure and response prevention still seems to be an important treatment option in terms of psychotherapeutic approaches. However, it is clear that a new approach is required in psychiatry practice in cases where exposure and response prevention and classical cognitive behavioral therapy are not sufficient and remain with residual symptoms. In this respect, metacognitive therapy can be an important alternative to fill this gap. However, more evidence needs to be created with studies with much larger samples.

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“…However, due to the high stakes of undergoing psychiatric neurosurgery, fostering trustful and enduring relationships is essential as well as followup offers that engage with personal patient needs and account for caregiver perspectives in setting psychiatric follow-up care provisions [77]. For psychiatric neurosurgical research, paying attention to the humanistic dimensions in medicine also requires to evaluate these treatments using patient-reported outcomes such as quality of life that encompass broader indicators of disease burden and patient-relevant outcomes [144].…”

Section: Discussion: Recommendation For Transferring Research To the ...mentioning

confidence: 99%

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

et al. 2022

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Background Psychiatric neurosurgery is experiencing a revival. Beside deep brain stimulation (DBS), several ablative neurosurgical procedures are currently in use. Each approach has a different profile of advantages and disadvantages. However, many psychiatrists, ethicists, and laypeople are sceptical about psychiatric neurosurgery. Methods We identify the main concerns against psychiatric neurosurgery, and discuss the extent to which they are justified and how they might be overcome. We review the evidence for the effectiveness, efficacy and safety of each approach, and discuss how this could be improved. We analyse whether and, if so, how randomised controlled trials (RCTs) can be used in the different approaches, and what alternatives are available if conducting RCTs is impossible for practical or ethical reasons. Specifically, we analyse the problem of failed RCTs after promising open-label studies. Results The main concerns are: (i) reservations based on historical psychosurgery, (ii) concerns about personality changes, (iii) concerns regarding localised interventions, and (iv) scepticism due to the lack of scientific evidence. Given the need for effective therapies for treatment-refractory psychiatric disorders and preliminary evidence for the effectiveness of psychiatric neurosurgery, further research is warranted and necessary. Since psychiatric neurosurgery has the potential to modify personality traits, it should be held to the highest ethical and scientific standards. Conclusions Psychiatric neurosurgery procedures with preliminary evidence for efficacy and an acceptable risk–benefit profile include DBS and micro- or radiosurgical anterior capsulotomy for intractable obsessive–compulsive disorder. These methods may be considered for individual treatment attempts, but multi-centre RCTs are necessary to provide reliable evidence.

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Neurobiological Mechanisms of Metacognitive Therapy – An Experimental Paradigm

Cited by 9 publications

References 57 publications

Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up

Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up

Metacognitive Therapy in Patients with ObsessiveCompulsive Disorder: A review

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

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