Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder.

Abstract

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.

• Authors: Helen B Simpson, Edna B Foa, Michael G Wheaton, Thea Gallagher, Marina Gershkovich, Andrew B Schmidt, Jonathan D Huppert, Raphael B Campeas, Patricia A Imms, Shawn P Cahill, Christina DiChiara, Steven D Tsao, Anthony C Puliafico, Daniel Chazin, Anu Asnaani, Kelly Moore, Jeremy Tyler, Shari A Steinman, Arturo Sanchez-LaCay, Sandy Capaldi, Ivar Snorrason, Elizabeth Turk-Karan, Donna Vermes, Eyal Kalanthroff, Anthony Pinto, Chang-Gyu Hahn, Bin Xu, Page E Van Meter, Martha Katechis, Jennifer Scodes, Yuanjia Wang
• Journal: Behaviour research and therapy (Behav Res Ther) Vol. 143 Pg. 103890 (08 2021) ISSN: 1873-622X [Electronic] England
• PMID: 34089924 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.

Chemical References

• Serotonin Uptake Inhibitors

Topics

• Adult
• Cognitive Behavioral Therapy
• Combined Modality Therapy
• Humans
• Obsessive-Compulsive Disorder (therapy)
• Patient Compliance
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Treatment Outcome