None listed
Conditions
Brief summary
The overall aim of this research is to examine the effectiveness of an integrated approach of transcranial direct current stimulation (tDCS) with cognitive behaviour therapy with exposure and response prevention, in the treatment of treatment refractory OCD. A case series will be conducted involving tDCS over the brain regions that have been implicated in OCD in a group of treatment resistant OCD patients. We hypothesise that the participants will show clinically and statistically significant improvement in their OCD symptoms, their depression and anxiety symptoms, a reduction in obsessive beliefs and an increase in their quality of life. We also anticipate that there will be an improvement in inhibitory control and cognitive flexibility, which are central to extinction and inhibitory learning associated with exposure and response prevention.
Interventions
Transcranial direct current stimulation (tDCS) and cognitive behaviour therapy with exposure and response prevention (ERP).
The participants will complete 10 sessions in total of tDCS stimulation to be conducted concurrently with ERP over four weeks, attending the clinic three times per week. Each session will be 50-minutes in duration. The session structure consists of a progress review and preparation for the in-session exposure exercise (approximately 10 minutes), followed by 20-minutes of t
Transcranial direct current stimulation (tDCS) and cognitive behaviour therapy with exposure and response prevention (ERP). The participants will complete 10 sessions in total of tDCS stimulation to be conducted concurrently with ERP over four weeks, attending the clinic three times per week. Each session will be 50-minutes in duration. The session structure consists of a progress review and preparation for the in-session exposure exercise (approximately 10 minutes), followed by 20-minutes of tDCS commenced in unison with the ERP exercises (see below), using a constant current of 2mA. Cathodal stimulation will be applied over the left Orbito Frontal Cortex to decrease neural activation, and anodal stimulation will be applied over the pre-supplementary motor area to increase neural activation. The cortical areas will be located using the 10-20 international system for EEG placement. The tDCS stimulation will time out after 20-minutes without disruption to engagement in ERP during the session. The ERP exercises will be continued for approximately 30 mins, leaving the final 10 minutes to debrief and plan any between sessions tasks. Exposure and Response Prevention. Exposure and Response Prevention treatments consist of two key elements: 1) exposure to thoughts, images, objects and/or situations that lead to distress and/or are linked to obsessional thinking, and 2) deliberate reduction and/or elimination of the usual compulsive behaviours engaged in once distress or obsessions have been triggered. The 10 session ERP sessions will adhere to the protocol published by Rees, C., & Anderson, R. (2009). Cognitive behavioural treatment manual for OCD: group and individual protocol. In C. Rees [ed.]. Obsessive-compulsive disorder: a practical guide to treatment. Melbourne: IP Communications. The Intervention will be administered by a post-graduate Clinical Psychology Trainee under the supervision of two senior academics with expertise in clinical and neuropsychology, and experience in tDCS delivery. Session attendance, and drop out will be monitored and noted for each client and included in the data set.
Sponsors
Curtin University Western Australia
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
A clinical diagnosis of DSM-5 OCD using the MINI International Neuropsychiatric Interview. Treatment Refractory, defined as a Yale-Brown Obsessive Compulsive Scale total score of > 16 (moderate to extreme) after two failed pharmacological treatments for OCD, and unsuccessful cognitive behaviour therapy with exposure and response prevention.
Exclusion criteria
Exclusion criteria: 1. Participants with a recent history of brain surgery, neurological condition associated with brain abnormalities (e.g., traumatic brain injury; recent stroke, tumour), implanted cranial devices, hearing aids (unless they can be removed), active skin lesions on the scalp. 2. History of migraine, epilepsy, seizures, unstable medical and/or psychiatric conditions; history of psychosis or bipolar disorder; high suicide/self-harm risk. 3. Current or past (within the last 1-month) use of benzodiazepines, anticonvulsants, Lithium Carbonate, psychostimulants, dextromethorphan and pseudoephedrine; recreational drug use. 4. Currently undergoing ERP therapy for OCD; any neuromodulation therapy (e.g., ECT, transcranial magnetic stimulation, tDCS) within the last 3-months. 5. Participants who have initiated or changed SSRI/SRI dose in the last 12 weeks.
Outcome results
None listed