Research News

Supervised by Dr. Roquia Begum

Abstract

Obsessive Compulsive Disorder (OCD) is the fourth most common mental disorders in Bangladesh and it is an extremely debilitating and frustrating disorder that interferes with virtually every aspect of everyday life. Cognitive behaviour therapy (CBT) is one of the most promising non-medication based psychotherapeutic interventions for treating OCD patient. But in Bangladesh, very few studies have been conducted on the efficacy of CBT in the treatment of OCD. Hence the present study aimed to investigate the effectiveness of CBT on patients with OCD. The specific objectives of the study were: i) To see the effectiveness of CBT on pharmacologically treatment resistant OCD patients ii) To compare the functional level changcs of the clients of non responders to medication before, mid and after receiving CBT treatment iii) To compare the functional level changes of the clients of non responders to medication (who did not receive CBT) between before, mid and after measure iv) To compare the functional level changes between the clients of non responders to medication who received CBT and the non responders who did not receive CBT. Present study adopted systematic case study design with before, mid, after and follow-up measurement. A CBT structure was developed for the assessment and treatment session for the patients who have treated under CBT. Besides this, adult initial assessment form. Anxiety Scale (Deeba & Begum, 2004), Depression Scale {Uddin & Rahman, 2005), Dhaka University Obsessive Compulsive Scale (Mozumder & Begum, 2005), Self-rating measurement scale (11 point verbal rating scale) were administered to measure the changes in the severity of the OCD. Purposive sampling technique was u.sed to select the sample of the present study. In the present study 14 adult clients were selected following inclusion criteria. All the clients were divided randomly into two groups. 7 (4 males and 3 females) clients were in group- A (Experimental group), they were non responders to medication and received CBT and other 7 (4 males and 3 females) clients were in group-B (Control group), they were also non responders to medication but they continue medication and received no CBT. The age of the clients ranged from 20 to 43 years. They were from lower middle class to upper middle class family. "I'heir educational levels were from class X to Bachelor Degree. 5 clients of all the clicnts were married and remaining 9 clients were unmarried. The samples were taken from the Psychiatry outpatient and/ or inpatient department of Bangabandhu Sheik Mujib Medical University (BSMMU) in Dhaka and Dhaka Medical College Hospital (DMCH). Pre-assessment measures were done for both groups with three semi-structurcd interview sessions and mid-assessment sessions were also done for both groups with one interview session. After completing the baseline measurement, intervention were applied on group-A for about 7-10 sessions (7-10 weeks). Finally for 6 clients from group-A, three fbllow-up measurements were also taken for one month and 15 days interval after the termination of the sessions but 1 client did not want to continue his follow up participation in the study. Also three follow-up measurements were taken for one month and 15 days interval after the termination of the sessions for 6 clients from group-B but 1 client did not w'ant to continue his follow up participation and 1 client did not want to continue lier post and follow-up participation in the study. Results were analyzed through content analysis and in-depth case study for both the groups. From the ease study and content analysis it was found that CBT was effective in reducing the severity of the symptoms. In the subjective rating the CBT group clients reported 75 to 90% reductions in their symptoms and the care givers reported 70 to 80% reductions of symptoms of the clients, The clients of group-B reported 0 to 25% reduction in their symptoms and the care givers reported 0 to 20% reductions of symptoms of the clients. Reports of the Psychiatrist also revealed higher improvement in experimental chents than control clients. Changes also differed according to their functional level. The subjective rating of problem severity was also consistent with the psychometric scale scores. The present study has some limitations. First, sample size was not big enough, only adults were selected and child clients were not included. Therefore, the findings of this study can not be generalized for all sorts of OCD clients. Second, the investigator and the therapist was the same person and it increased the probability of subjective bias. Nevertheless, the present study developed a guideline for the CBT therapist for the treatment of OCD. From the results of the study it was found that CBT could bring a positive change among the OCD patients and therefore, it can be concluded that CBT is effective in treating patients with OCD and medicine resistance patients could reduce their symptoms if CBT is given with medicine