Willingness to experience unpleasant thoughts, emotions, and bodily sensations at admission does not predict treatment outcome in inpatients with obsessive-compulsive disorder.
Exposure and response prevention
Inpatient treatment
Obsessive–compulsive disorder
Psychotherapy
Willingness
Journal
Discover mental health
ISSN: 2731-4383
Titre abrégé: Discov Ment Health
Pays: Switzerland
ID NLM: 9918350483906676
Informations de publication
Date de publication:
06 Jun 2024
06 Jun 2024
Historique:
received:
13
12
2023
accepted:
24
05
2024
medline:
7
6
2024
pubmed:
7
6
2024
entrez:
6
6
2024
Statut:
epublish
Résumé
Some persons with obsessive-compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet. We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions. Obsessive-compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps < 0.001) and global functioning (based on therapist ratings) increased with a large effect size (d = 1.3, p < 0.001) from admission to discharge. In contrast to previous findings, however, WTE did not predict treatment outcome (all ps > 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables. Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive-compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.
Sections du résumé
BACKGROUND
BACKGROUND
Some persons with obsessive-compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet.
METHODS
METHODS
We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions.
RESULTS
RESULTS
Obsessive-compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps < 0.001) and global functioning (based on therapist ratings) increased with a large effect size (d = 1.3, p < 0.001) from admission to discharge. In contrast to previous findings, however, WTE did not predict treatment outcome (all ps > 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables.
CONCLUSIONS
CONCLUSIONS
Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive-compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.
Identifiants
pubmed: 38844591
doi: 10.1007/s44192-024-00073-6
pii: 10.1007/s44192-024-00073-6
doi:
Types de publication
Journal Article
Langues
eng
Pagination
20Informations de copyright
© 2024. The Author(s).
Références
Abramowitz J, Reuman L. Obsessive compulsive disorder. In: Zeigler-Hill V, Shackelford TK, editors. Encyclopedia of personality and individual differences. Cham: Springer; 2009. p. 3304–6.
Goodman WK, Grice DE, Lapidus KA, Coffey BJ. Obsessive-compulsive disorder. Psychiatric Clin North Am. 2014;37(3):257–67.
doi: 10.1016/j.psc.2014.06.004
Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry. 2020;81(4):13075.
doi: 10.4088/JCP.19r13085
Remmerswaal KC, Batelaan NM, Hoogendoorn AW, van der Wee NJ, van Oppen P, van Balkom AJ. Four-year course of quality of life and obsessive–compulsive disorder. Soc Psychiatry Psychiatr Epidemiol. 2020;55(8):989–1000.
doi: 10.1007/s00127-019-01779-7
pubmed: 31541270
Sheu JC, McKay D, Storch EA. COVID-19 and OCD: Potential impact of exposure and response prevention therapy. J Anxiety Disord. 2020;76:102314.
doi: 10.1016/j.janxdis.2020.102314
pubmed: 32980748
pmcid: 7507975
Voderholzer U, Favreau M, Rubart A, Staniloiu A, Wahl-Kordon A, Zurowski B, et al. Therapie der Zwangsstörungen: Empfehlungen der revidierten S3-Leitlinie Zwangsstörungen Therapy for obsessive-compulsive disorder: Recommendations of the revised S3-guideline obsessive-compulsive disorders. Der Nervenarzt. 2022. https://doi.org/10.1007/s00115-022-01336-9 .
doi: 10.1007/s00115-022-01336-9
pubmed: 35833969
pmcid: 9452431
Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2016;3(8):730–9.
doi: 10.1016/S2215-0366(16)30069-4
pubmed: 27318812
pmcid: 4967667
Öst L-G, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clin Psychol Rev. 2015;40:156–69.
doi: 10.1016/j.cpr.2015.06.003
pubmed: 26117062
Ong CW, Clyde JW, Bluett EJ, Levin ME, Twohig MP. Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? J Anxiety Disord. 2016;40:8–17.
doi: 10.1016/j.janxdis.2016.03.006
pubmed: 27061971
Schruers K, Koning K, Luermans J, Haack M, Griez E. Obsessive–compulsive disorder: a critical review of therapeutic perspectives. Acta Psychiatr Scand. 2005;111(4):261–71.
doi: 10.1111/j.1600-0447.2004.00502.x
pubmed: 15740462
Reid AM, Garner LE, Van Kirk N, Gironda C, Krompinger JW, Brennan BP, et al. How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder. Depress Anxiety. 2017;34(11):1057–64.
doi: 10.1002/da.22672
pubmed: 28715850
Eddy KT, Dutra L, Bradley R, Westen D. A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev. 2004;24(8):1011–30.
doi: 10.1016/j.cpr.2004.08.004
pubmed: 15533282
Fisher PL, Wells A. How effective are cognitive and behavioral treatments for obsessive–compulsive disorder? A clinical significance analysis. Behav Res Ther. 2005;43(12):1543–58.
doi: 10.1016/j.brat.2004.11.007
pubmed: 16239151
Voderholzer U, Favreau M, Rubart A, Staniloiu A, Wahl-Kordon A, Zurowski B, et al. Therapie der Zwangsstörungen: empfehlungen der revidierten S3-Leitlinie Zwangsstörungen. Der Nervenarzt. 2022. https://doi.org/10.1007/s00115-022-01336-9 .
doi: 10.1007/s00115-022-01336-9
pubmed: 35833969
pmcid: 9452431
Gönner S, Leonhart R, Ecker W. Das Zwangsinventar OCI-R - die deutsche version des obsessive-compulsive inventory-revised [The questionnaire OCI-R—the german version of the obsessive-compulsive inventory-revised]. PPmP-Psychother·Psych·Med Psychol. 2007;57(2):395–404.
Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, et al. The obsessive-compulsive inventory: development and validation of a short version. Psychol Assess. 2002;14(4):485–96.
doi: 10.1037/1040-3590.14.4.485
pubmed: 12501574
Hand I, Büttner-Westphal H. Die yale-brown obsessive-compulsive scale (Y-BOCS): Ein halbstrukturiertes interview zur Beurteilung des Schweregrades von Denk-und Handlungszwängen. Verhaltenstherapie. 1991;1(3):223–5.
doi: 10.1159/000257972
Goodman W, Rasmussen S, Price L, Mazure L, Heninger G, Charney D. Yale-brown obsessive compulsive scale (Y-BOCS). Verhaltenstherapie. 1991;1(3):226–33.
doi: 10.1159/000257973
Association AP. Diagnostic and statistical manual of mental disorders, 4th edn revised. Washington DC: American Psychiatric Association; 1994. p. 317–92.
Guy W. Assessment manual for psychopharmacology. Rockville: National Institute of Mental Health; 1976. p. 217–22.
RCore Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2022.
RStudio Team. RStudio integrated development for R. Boston: RStudio Team, PBC; 2022.
JASP Team. JASP [Computer software]. 2022.
Mair P, Wilcox R. Robust statistical methods in R using the WRS2 package. Behav Res Methods. 2020;52(2):464–88.
doi: 10.3758/s13428-019-01246-w
pubmed: 31152384
Wilcox RR. The percentage bend correlation coefficient. Psychometrika. 1994;59(4):601–16.
doi: 10.1007/BF02294395
Maechler M, Rousseeuw P, Croux C, Todorov V, Ruckstuhl A, Salibian-Barrera M, et al. Package ‘Robustbase’. 2022.
Benjamin DJ, Berger JO, Johannesson M, Nosek BA, Wagenmakers E-J, Berk R, et al. Redefine statistical significance. Nat Hum Behav. 2018;2(1):6–10.
doi: 10.1038/s41562-017-0189-z
pubmed: 30980045
van Geijtenbeek-devanVosSteenwijk M, de Leeuw A, van Megen H, Selier J, Visser H. Proof of principle: is a pre-treatment behavior approach test a potential predictor for response to intensive residential treatment in patients with treatment refractory obsessive compulsive disorder? Front Psychiatry. 2021;12:662069.
doi: 10.3389/fpsyt.2021.662069
Hansmeier J, Haberkamp A, Glombiewski JA, Exner C. The behavior avoidance test: association with symptom severity and treatment outcome in obsessive-compulsive disorder. Front Psych. 2021;12:781972.
doi: 10.3389/fpsyt.2021.781972
Wheaton MG, Gershkovich M, Gallagher T, Foa EB, Simpson HB. Behavioral avoidance predicts treatment outcome with exposure and response prevention for obsessive–compulsive disorder. Depress Anxiety. 2018;35(3):256–63.
doi: 10.1002/da.22720
pubmed: 29394511
pmcid: 6945296
Steketee G, Chambless DL, Tran GQ, Worden H, Gillis MM. Behavioral avoidance test for obsessive compulsive disorder. Behav Res Ther. 1996;34(1):73–83.
doi: 10.1016/0005-7967(95)00040-5
pubmed: 8561767
Diedrich A, Sckopke P, Schwartz C, Schlegl S, Osen B, Stierle C, et al. Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder–a process-outcome study. BMC Psychiatry. 2016;16(1):1–10.
doi: 10.1186/s12888-016-0914-6
Schwartz C, Hilbert S, Schubert C, Schlegl S, Freyer T, Löwe B, et al. Change factors in the process of cognitive-behavioural therapy for obsessive-compulsive disorder. Clin Psychol Psychother. 2017;24(3):785–92.
doi: 10.1002/cpp.2045
pubmed: 27699920
Foa EB, Simpson HB, Gallagher T, Wheaton MG, Gershkovich M, Schmidt AB, et al. Maintenance of wellness in patients with obsessive-compulsive disorder who discontinue medication after exposure/response prevention augmentation: a randomized clinical trial. JAMA Psychiat. 2022;79(3):193–200.
doi: 10.1001/jamapsychiatry.2021.3997