Acceptance and Commitment Therapy in SSRI-Resistant Obsessive Compulsive Disorder

Study Overview
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Brief Summary
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The purpose of this study is to determine whether acceptance and commitment therapy is effective in the treatment of SSRIs-resistant obsessive- compulsive disorder.

Detailed Description
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The patients who were SSRI-resistant will be randomized to ACT, aripiprazole, or SMT. Independent evaluators, blind to treatment,will evaluate patients during the study.The Yale-Brown Obsessive Compulsive Scale (YBOCS)will be used to measure OCD severity.

Official Title
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Acceptance and Commitment Therapy in SSRI-Resistant Obsessive Compulsive Disorder

Conditions
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Obsessive-Compulsive Disorder

Intervention / Treatment
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* Behavioral: Acceptance and commitment therapy
* Drug: Aripiprazole
* Behavioral: Stress management training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age between 18 and 65; no less than 9 years in education; a DSM-IV diagnosis of OCD moderately symptomatic (Yale-Brown Obsessive Compulsive Scale score≥16) received at least two kinds of SSRIs at optimal dose for more than 12 weeks An optimal dose is described as following: clomipramine hydrochloride, at least 225 mg/d;fluoxetine, at least 60 mg/d; paroxetine hydrochloride, at least 60 mg/d; sertraline hydrochloride, at least 200 mg/d; fluvoxamine, at least 250 mg/d; citalopram hydrobromide,at least 60 mg/d; and escitalopram oxalate, at least 40 mg/d.Patients who are unable to tolerate the supposed optimal doses were also eligible if at their maximally tolerated dose. Exclusion Criteria: with comorbid Axis I psychiatric disorders drug abuse in the last 3 months HAMD>25 too severe to receive ACT or evaluation at high risk of suicide pregnant or prepare for pregnancy with somatic disorder received aripiprazole(≥10mg for 8weeks) or ACT(8 times within 2 months) before treated with no more than one kind of SSRI before

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Acceptance and commitment therapy<br>Patients randomized to ACT will receive weekly 45-50 minute sessions delivered over 8 weeks by a therapist. ACT will include mindfulness,learning new methods to handle problems，acceptance of thoughts and feelings, learning to disempower thoughts and feelings, and values-based committed action. | Behavioral: Acceptance and commitment therapy<br>* Patients randomized to ACT will receive weekly 45-50 minute sessions delivered over 8 weeks by a therapist. ACT will include mindfulness,learning new methods to handle problems，acceptance of thoughts and feelings, learning to disempower thoughts and feelings, and values-based committed action.<br>|
| Active Comparator: Aripiprazole<br>Patients randomized to aripiprazole group will be treated with aripiprazole at the dose of 10-20mg/day for 8 weeks. | Drug: Aripiprazole<br>* Patients randomized to aripiprazole group will be treated with aripiprazole at the dose of 10-20mg/day for 8 weeks.<br>|
| Other: Stress management training<br>Patients randomized to SMT group will be received 2 introductory sessions and 15 treatment sessions. SMT will include training of stress manage-ment skills, progressive muscle relaxation,positive imagery, assertiveness training, and problem solving. | Behavioral: Stress management training<br>* Patients randomized to SMT group will be received 2 introductory sessions and 15 treatment sessions. SMT will include training of stress manage-ment skills, progressive muscle relaxation,positive imagery, assertiveness training, and problem solving.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Yale Brown Obsessive Compulsive Scale | Change from baseline Y-BOCS score at 8 weeks | 0,8week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Beck Depression Inventory |  | 0,8week | 
| Acceptance and Action Questionnaire |  | 0,8week | 
| Treatment Evaluation Inventory-Short Form |  | 0,8week | 
| Basic life sign |  | 0,8week | 
| BMI |  | 0,8week | 
| Abnormal Involuntary Movement Scale |  | 0,8week |