Plain English Summary
Background and study aims
Obsessive-compulsive disorder is a major mental disorder. About 40% of patients are not helped by available treatments. New approaches are needed. One promising treatment is transcranial direct current stimulation (tDCS). tDCS uses an electrode placed for a short time on the scalp to pass a small, almost imperceptible electric current into brain areas connected to OCD. This may help people with OCD think and behave differently and could help existing treatments work better. tDCS is relatively new and experimental in OCD though it has been used with some success in depression. This small-sized study is a pilot (feasibility study) preparing for a larger trial. The aim is to answer basic questions, including if tDCS lessens OCD symptoms, the nature and severity of any side effects and if doctors and patients are willing to use it. The researchers also investigate which specific brain areas should be targeted and how long positive effects last. This information would help the design and conduct of larger clinical trials.
Who can participate?
Treatment-seeking adults with OCD are recruited from mental health units, GP referrals and improved access to psychological therapies services.
What does the study involve?
The study takes place in community mental health facilities. Twenty-five patients with OCD receive three courses of four twice-daily 20-minute sessions of tDCS (either active or sham stimulation) delivered to two separate brain targets. The courses are allocated in a random order. Each 2-day course of tDCS is spaced 4 weeks apart to avoid ‘carry over’ effects, and see how long the effects last. Patients are asked about the experience and have their symptoms and any side effects assessed using questionnaires. The assessor will not know which patients have received which course of treatment to reduce bias. Patients are asked if they found the treatment acceptable.
What are the possible benefits and risks of participating?
Those taking part in the study will have the chance to receive transcranial direct current stimulation (tDCS) which may turn out to be a helpful new treatment for OCD. However, the short course of stimulation received is not expected to provide real lasting clinical benefit. Participants will also have the opportunity to receive extra detailed assessments conducted by a member of the research team. The information gained from this study will help the researchers to decide whether or not to set up a larger study which in turn should provide information for improving the treatment of OCD. It is important to stress that the tDCS equipment used is designed to be used by patients with depression at their home without supervision. The researchers will be using it in a controlled laboratory environment under constant supervision. It is not anticipated that there will be any severe side effects from taking part in this study.
Where is the study run from?
Southampton University (UK)
When is the study starting and how long is it expected to run for?
December 2018 to December 2020
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
1. Roisin Mooney
r.mooney@herts.ac.uk
2. Prof. Naomi Fineberg
Naomi.fineberg@nhs.net
Trial website
Contact information
Type
Scientific
Primary contact
Miss Roisin Mooney
ORCID ID
Contact details
University of Hertfordshire
College Lane Campus
Hatfield
AL10 9AB
United Kingdom
+44 (0)1707 283292
r.mooney@herts.ac.uk
Type
Scientific
Additional contact
Prof Naomi Fineberg
ORCID ID
Contact details
Rosanne House
Dept of Psychiatry
OCD Specialist Service
Welwyn Garden City
AL8 6HG
United Kingdom
+44 (0)1707 364055
Naomi.fineberg@nhs.net
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
CPMS: 41100
Study information
Scientific title
Feasibility and acceptability of transcranial stimulation in obsessive-compulsive symptoms
Acronym
FEATSOCS
Study hypothesis
Obsessive-compulsive disorder is a major mental disorder. About 40% of patients are not helped by available treatments. New approaches are needed. One promising treatment is transcranial direct current stimulation (tDCS). tDCS uses an electrode placed for a short time on the scalp to pass a small, almost imperceptible electric current into brain areas connected to OCD. This may help people with OCD think and behave differently and could help existing treatments work better. tDCS is relatively new and experimental in OCD though it has been used with some success in depression. This small-sized study is a pilot (feasibility study) preparing for a larger trial. The aim is to answer basic questions, including if tDCS lessens OCD symptoms, the nature and severity of any side effects and if doctors and patients are willing to use it. The researchers also investigate which specific brain areas should be targeted and how long positive effects last. This information would help the design and conduct of larger clinical trials.
Ethics approval
Approved 27/03/2019, East of England - Cambridgeshire and Hertfordshire Research Ethics Committee (The Old Chapel, Royal Standard Place, Nottingham, NG1 6FS, UK; Tel: +44 (0)2071048102), ref: 19/EE/0046
Study design
Randomised; Interventional; Design type: Treatment, Device
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Community
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Obsessive-compulsive disorder
Intervention
In this study, treatment-seeking adults with OCD are recruited from mental health units, GP referrals and improved access to psychological therapies services. Twenty-five patients with OCD will receive three courses of four twice-daily 20-minute sessions of tDCS (either active or sham stimulation) delivered to 2 separate brain targets. The courses are allocated in a randomised order. Each 2-day course of tDCS is spaced 4 weeks apart to avoid ‘carry over’ effects, and see how long the effects last. Patients will be asked about the experience and have their symptoms and any side effects assessed using questionnaires. The assessor will not know which patients have received which course of treatment to reduce bias. The researchers will ask patients if they found the treatment acceptable. Recruitment is expected to take 12 months.
Intervention type
Procedure/Surgery
Phase
Drug names
Primary outcome measure
1. Acceptability, tolerability and safety of the intervention is determined using treatment logs recorded during and following study visits. Specifically:
1.1. Sessions completed and missed (acceptability, tolerability)
1.2. Recording of issues raised by patients at any point during the study. Adverse events reported at any point, specifically recorded at study visits (safety)
2. Feasibility of recruitment is determined using logs of referral into the services, by recording the numbers of potential patients, as well as why patients were excluded at each point, and the number of patients consented.
3. Adherence to tDCS and the study protocol assessed by recording sessions, and the proportion of study outcomes completed is determined using notes on issues raised by patients and researchers that are recorded during the study.
4. Willingness evaluated by recording the numbers of key staff approached, those declining study participation and the reasons given.
5. tDCS in a clinical setting assessed by recording any issues relating to setting up the sessions, delivery of the stimulation, and issues raised by the participants during or in the hours after the stimulation sessions. Difficulties with the application of the treatment protocols and equipment failures are noted
Secondary outcome measures
Current secondary outcome measures as of 24/07/2019:
1. Optimal stimulation target (OFC, SMA) effect on OCD symptoms is measured using Y-BOCS and Y-BOCS challenge (as appropriate)scores utilising all available data (from 1 hour after the first stimulation to 14 days after the last stimulation).
2. Likely magnitude of the effect of the intervention on OCD symptoms is measured using the Y-BOCS 24 hours after the final stimulation.
3. Duration of effect of stimulation is measured separately for the OFC and SMA targets using paired tests usingY-BOCS and Y-BOCS Challenge at all time points following the first stimulation.
4. Usefulness and limitations of specific neurocognitive tests is measured using the CANTAB (stop signal reaction time test, intra-extradimensional set shift), Prisoner's Dilemma test (cooperation test), andFabulous Fruit game (habit learning test) at baseline and 3 hours.
Previous secondary outcome measures:
1. Optimal stimulation target (OFC, SMA) effect on OCD symptoms is measured using Y-BOCS and Y-BOCS challenge (as appropriate) scores utilising all available data (from 1 hour after the first stimulation to 14 days after the last stimulation)
2. Likely magnitude of the effect of the intervention on OCD symptoms is measured using the Y-BOCS 24 hours after the final stimulation
3. Duration of effect of stimulation is measured separately for the OFC and SMA targets using paired tests using Y-BOCS and Y-BOCS Challenge at all timepoints following the first stimulation
4. Usefulness and limitations of specific neurocognitive tests are measured using the CANTAB (stop signal reaction time test, intra-extradimensional set shift), Prisoner's Dilemma test (cooperation test), and Fabulous Fruit game (habit learning test) at baseline and 3 hours
Overall trial start date
01/12/2018
Overall trial end date
01/12/2020
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Community-based service-users, aged 18-65 years
2. DSM-5 defined obsessive-compulsive disorder determined by a research psychiatrist using the structured interview for DSM-5
3. Duration of symptoms > 1 year (from medical history)
4. Baseline score > = 20 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
5. Ongoing medication (SSRI, tricyclic antidepressant, antipsychotic, benzodiazepine) is allowed as long as the dose is kept stable for a sustained period before (> = 6 weeks) randomisation and remains so throughout the study. CBT is not allowed during or within 6 weeks of the start of the intervention
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
Planned Sample Size: 25; UK Sample Size: 25
Participant exclusion criteria
1. History of psychotic disorder (schizophrenia, psychotic symptoms, bipolar disorder), Tourette syndrome (tic disorders not amounting to Tourette syndrome will not be exclusionary), organic mental disorder, psychosurgery, personality disorder of borderline or histrionic type
2. Alcohol/substance-abuse disorders within the past 12 months
3. Any other DSM-5 disorder that is considered the primary focus of treatment
4. Severe depression, defined by a Montgomery-Åsberg Depression Rating Scale (MÅDRS) score > 30 at baseline
5. Actively planning suicide (scoring 5 or 6 on item 10 of MADRS) or judged by the clinician to be at significant risk of self-harm
6. Received CBT involving ERP from an accredited (British Association of Behavioural and Cognitive Psychotherapies (BABCP) approved or equivalent) therapist (e.g. IAPTs stage 2) in the last 6 weeks
7. Highly CBT resistant (inadequate clinical response, equivalent to < 25% improvement) > = 3 previous adequate (> 12 weeks) trials of CBT involving ERP from an accredited (BABCP-approved or equivalent) therapist
8. Highly medication resistant (inadequate clinical response, equivalent to < 25% improvement) > = 3 previous adequate (> 12 weeks) trials of any SSRI or clomipramine taken at optimal doses with adequate adherence
9. Needing regular psychotropic drugs other than permitted medication
10. Currently involved in a treatment research study
11. Acute or unstable physical illness
12. Skull defects, or skin lesions on scalp (cuts, abrasions, rash) at proposed electrode sites
13. History of surgical procedure with implanted body materials or devices (e.g. metal, pacemakers)
14. Epilepsy or other clinically defined neurological disorder or insult
15. Inadequate understanding of English to give informed consent or such that the outcome measurement is impossible
16. Women of child-bearing age not using reliable contraception (e.g. oral contraception pill, intra-uterine contraceptive device or condom)
17. Pregnant or breastfeeding women
Recruitment start date
15/07/2019
Recruitment end date
15/07/2020
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Rosanne House
HPFT
Welwyn Garden City
AL8 6HG
United Kingdom
Trial participating centre
Southampton University Department of Psychiatry
College Keep
4-12 Terminus Terrace
Southampton
SO14 3DT
United Kingdom
Sponsor information
Organisation
Hertfordshire Partnership University NHS Foundation Trust
Sponsor details
c/o Tim Gale
HPFT Learning and Development Centre
The Colonnades
Beaconssfield Road
Hatfield
AL10 8YE
United Kingdom
+44 (0)1707253837
t.gale@herts.ac.uk
Sponsor type
Hospital/treatment centre
Website
Funders
Funder type
Government
Funder name
NIHR Central Commissioning Facility (CCF); Grant Codes: PB-PG-1216-20005
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
1. Peer-reviewed scientific journals
2. Internal report
3. Conference presentation
4. Publication on website
5. Other publication
6. Submission to regulatory authorities
7. Access to raw data and right to publish freely by all investigators in study or by Independent Steering Committee
on behalf of all investigators
IPD sharing statement
The data sharing plans for the current study are unknown and will be made available at a later date
Intention to publish date
01/05/2021
Participant level data
To be made available at a later date
Basic results (scientific)
Publication list