Vicky Simkin
Academic and research departments
Clinical Intervention and Practice Research Group, School of Psychology.ResearchResearch interests
OCD and anxiety disorders
Research projects
Treatment response in OCD is defined as a 35% reduction on the Y-BOCS. However, scores indicating treatment response and remission on the FOCI have not yet been established. Using ROC analysis, this study found a 25% reduction on the FOCI best corresponds to a 35% reduction on the Y-BOCS. As the FOCI is a shorter, less time-intensive measure that imposes less burden on clients and clinicians, we hope establishing treatment response indicators is a first step to precede the FOCI being used more widely as an outcome measure in services.
Exploring the relationship between symptoms of OCD and depression during ERP for OCD using RI-CLPMWe know little about how symptoms of obsessive-compulsive disorder and depression interact during a psychological therapy. Previous studies suggest that reductions in the severity of deression are driven by reductions in OCD, implying that it is sufficient to target the OCD alone as a means to reduce symptoms of both disorders. However, due to the exclusion of individuals with severe depression and limitations of the statistical approaches used in previous research, support for this conclusion is limited. This study re-examined the interaction between symptoms of OCD and depression during therapy using more robust statistical methods in a sample of individuals with a full range of severity of depression. Participants were 137 adults in a specialist residential unit with a primary diagnosis of OCD. They completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. All participants received a 12 to 16-week residential program. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model. Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD. Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. If anything, the influence of depression on OCD is more consistent than vice-versa. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD.
Research interests
OCD and anxiety disorders
Research projects
Treatment response in OCD is defined as a 35% reduction on the Y-BOCS. However, scores indicating treatment response and remission on the FOCI have not yet been established. Using ROC analysis, this study found a 25% reduction on the FOCI best corresponds to a 35% reduction on the Y-BOCS. As the FOCI is a shorter, less time-intensive measure that imposes less burden on clients and clinicians, we hope establishing treatment response indicators is a first step to precede the FOCI being used more widely as an outcome measure in services.
We know little about how symptoms of obsessive-compulsive disorder and depression interact during a psychological therapy. Previous studies suggest that reductions in the severity of deression are driven by reductions in OCD, implying that it is sufficient to target the OCD alone as a means to reduce symptoms of both disorders. However, due to the exclusion of individuals with severe depression and limitations of the statistical approaches used in previous research, support for this conclusion is limited. This study re-examined the interaction between symptoms of OCD and depression during therapy using more robust statistical methods in a sample of individuals with a full range of severity of depression. Participants were 137 adults in a specialist residential unit with a primary diagnosis of OCD. They completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. All participants received a 12 to 16-week residential program. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model. Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD. Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. If anything, the influence of depression on OCD is more consistent than vice-versa. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD.
Publications
Response in the treatment of OCD has been defined by an international consensus as ≥35% reduction on a clinician rated interview, the Yale-Brown Obsessive Scale (Y– BOCS). Remission is defined as a score of ≤12 on the Y-BOCS. However, clinicians do not routinely use an observer rated scale for measuring outcomes as this requires training as well as resources to administer it. The Florida Obsessive Compulsive Inventory (FOCI) is a 5 item self-report scale that can be used for measuring change during treatment. Scores from a clinical service were used to calculate the cut-off scores for response and remission compared to the Y-BOCS and evaluated using receiver operating curves (ROC) analysis. We found that a reduction of 25% on the FOCI best corresponded to a reduction on the Y-BOCS of 35%. A score ≤7 on the FOCI at post-treatment was the optimal cut-off in determining full or partial remission from OCD. A reliable improvement was found to be a score of 6. This may assist clinicians in treatment evaluation and enable comparisons with results from clinical trials, when the Y-BOCS is not available. In a separate out-patient sample we found that the FOCI was just as sensitive to change with the same effect size as the Obsessive-Compulsive Inventory (OCI) and Obsessive-Compulsive Inventory-Revised (OCI-R). The FOCI imposes significantly less burden on clients, being only 5 items, and should be adopted more widely as an outcome measure in OCD.