“Data indicated that individuals with higher willingness during ERP [exposure and response prevention] reported faster symptom reduction during residential treatment, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals performed during ERP,” Adam M. Reid, Ph.D., of the OCD Institute for Children and Adolescents at McLean Hospital and colleagues wrote.
Reid and colleagues set out to explore why ERP—considered the gold-standard psychotherapeutic treatment for OCD—is not fully effective for more patients with OCD. ERP is considered effective for about 50% to 80% of adults with OCD.
Previous research by others on acceptance and commitment therapy suggested that willingness is a marker of acceptance and is associated with improved engagement in distressing tasks. Reid and colleagues decided this would be an important factor on which to focus for their ERP research.
For the current study, 288 adults seeking treatment at an intensive/residential treatment (IRT) program for OCD participated in 4 hours of ERP per day for six weeks. About 25% to 50% of the sessions were led by trained clinical residence counselors or practicum students, and the remainder were self-directed. During each coached exposure session, coaches asked patients to rate how willing they felt before and during the exposure, as well as how willing they would be to repeat the exposure in the future. Willingness was rated on a scale of 0 (not at all willing) to 100 (extremely willing). The 10-item Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used for assessing symptom severity.
Average Y-BOCS scores at baseline were 25.42, indicating that the average patient in the study had clinically severe OCD. After six weeks of ERP, OCD symptoms fell an average of 8.16 points on the Y-BOCS, resulting in an average reduction of 31% in symptoms. Higher willingness to engage in ERP was associated with more adherence, less ritualizing, and more habituation during ERP.
Reid and colleagues also asked patients to self-report their willingness to engage in ERP at three different time points: before ERP, immediately after, and for future exposures. Higher willingness at each time point was found to be associated with faster symptom reduction during six weeks of residential-level exposure therapy.
“Perhaps patients with higher willingness are more amenable to facing a higher number of novel stimuli and environments during exposure therapy,” the authors wrote. “[W]illingness may provide a clinical marker of exposure response that can be feasibly captured by clinicians in a naturalistic clinical setting.”
For related information, see the Psychiatric News article “Report Highlights Alternative Treatment Options for OCD.”