"Association Splitting" in Obsessive-Compulsive Disorder (OCD)
Condition: Obsessive-Compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Study type: Interventional

Summary: 
      Over a period of 3 weeks, association splitting is compared to cognitive remediation (CogPack
      training) as an add-on intervention to cognitive-behavioral therapy (CBT). Blind to treatment
      assignment, both groups are assessed before intervention and eight weeks as well as six
      months later with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the
      Obsessive-Compulsive Inventory (OCI-R) and cognitive tests. OCD severity as measured by the
      Y-BOCS total score serves as the primary outcome parameter. It is assumed that association
      splitting will improve OCD severity to a greater extent than cognitive remediation.
    

Detailed description: 
      Association splitting is a new cognitive technique which aims at reducing obsessive thoughts.
      It draws upon the so-called "fan effect" of associative priming. Transposing this principle
      to the treatment of obsessive-compulsive disorder (OCD), we hypothesized that the sprouting
      of new and the strengthening of existing neutral associations to core OCD cognitions will
      reduce their fear-evoking properties by depriving the chain of OCD-related cognitions of
      associative strength. Patients with OCD are randomly allocated to either associations
      splitting (AS) or cognitive remediation (CogPack training). Blind to treatment assignment,
      both groups are assessed before intervention and eight weeks as well as six months later with
      the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory
      (OCI-R) and cognitive tests. OCD severity derived from the Y-BOCS and the OCI-R serves as the
      main outcome parameters. We also explore if AS changes the OCD-related semantic networks with
      cognitive tasks. It is assumed that association splitting will improve OCD severity to a
      greater extent than CogPack training.
    

Intervention name(s): "association splitting"; cognitive remediation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): "Association splitting" is a cognitive intervention which aims at reducing obsessive thoughts. Association splitting is based on the so called fan effect (Anderson, 1974) and aims at reducing the strength of obsessive cognitions. For this purpose core intrusive thoughts are identified with the patient (such as "cancer - illness") and the patient is encouraged to find non-OCD associations that are (semantically or phonologically) related to the OCD cognition (such as "cancer - (zodiac) sign", "cancer - great crab"). To strengthen the novel connections, these associations are elaborated by the use of pictures, music, or smells. By enhancing OC-unrelated associations it is assumed that the influence of OC-related concepts is weakened.; Computerized cognitive remediation (CogPack training). A fixed sequence is administered, which covers a wide range of neuropsychological exercises involving memory, reasoning, selective attention and psychomotor speed. The difficulty level for each patient is adapted automatically depending on to the subject's performance on prior exercises. At the end of each session, the patient receives individual feedback on his or her performance. To match with association splitting, six sessions are administered. Each session lasts approximately 45-60 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: OCD; obsessions; cognitive