“Association Splitting” Versus Cognitive Remediation in Obsessive-Compulsive Disorder: A Randomized Controlled Trial

Publication date: Available online 31 March 2018
Source:Journal of Anxiety Disorders
Author(s): Lena Jelinek, Marit Hauschildt, Birgit Hottenrott, Michael Kellner, Steffen Moritz
Studies have confirmed the efficacy of the cognitive intervention Association Splitting (AS) in obsessive-compulsive disorder (OCD) when applied as a self-help technique. AS aims to alter symptom-provoking automated cognitive networks of OC-related stimuli by building new or strengthening established but weak neutral associations. The aim of this study was to investigate the acceptance and benefits of therapist-assisted AS as an add-on to cognitive behavioral therapy (CBT). One hundred and nine patients with OCD who were undergoing CBT were randomly assigned to either AS or cognitive remediation (CR). Both groups were assessed at baseline, 4 weeks and 6 months later. The primary measure was the Yale-Brown Obsessive Compulsive Scale. Although patients' acceptance of AS was good, there was no evidence for the superiority of AS over CR regarding overall symptom severity. A larger decrease was found from baseline to 6 months follow-up in AS regarding avoidance. Moreover, subsidiary analyses excluding control patients who had obtained information about AS indicated its superiority. Despite high acceptance, we found no clear additional effect of AS beyond CBT treatment. Because superiority of AS was found in post hoc analyses excluding control patients who had obtained information on AS, we suggest that contagion effects deserve consideration.



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