Post-treatment predictors of follow-up status for obsessive-compulsive disorder treated with concentrated exposure therapy

Abstract

Recommended psychological treatment for obsessive-compulsive disorder (OCD) is cognitive behavioral therapy (CBT) including exposure with response prevention (ERP). Previous studies have identified few consistent predictors of both short- and long-term treatment outcomes in CBT for OCD. The aim of the current study was to investigate the relation between the combined burden of three post-treatment predictors (subclinical symptoms of OCD, anxiety, and depression) and long-term treatment outcome. A total of 97 patients with a diagnosis of OCD from an outpatient clinic in Norway completed a concentrated four-day group treatment of ERP for OCD. Results revealed that patients in the high-risk group had 2.5 times the risk (odds ratio = 10.1) of having OCD at follow-up compared to patients in the low risk group. Pre-treatment levels of depression, anxiety and OCD were not significantly related to follow-up status. The results indicate an advantage of a combined post-treatment predictor model over single pre-treatment predictors. Furthermore, we argue that the intensive four-day treatment format provides a unique setting for investigating predictors of treatment outcome.

Keywords:

• obsessive compulsive disorder
• predictors
• exposure and response prevention
• intensive treatment
• anxiety
• depression

Public Interest Statement

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by intrusive thoughts (obsessions) which provoke strong anxiety. Patients try to control anxiety with rituals (compulsions). Recommended psychological treatments for OCD are cognitive behavioral therapy and exposure therapy. However, about 30% of patients do not benefit fully from treatment. We set out to investigate whether subclinical levels of anxiety, depression, and OCD symptoms at the end of treatment could predict long term treatment outcome. Our study revealed that 72% of patients with no risk factors succeeded in the long run, while only 17% of the patients with all tree risk factors succeeded. These results suggest that therapists should monitor these risk factors in order to avoid patients relapsing.

Competing Interests

The authors declare no competing interest.

Additional information

Notes on contributors

Silje Elisabeth Hasmo Holm

Silje Elisabeth Hasmo Holm is a clinical psychologist and PhD candidate in Helse Vest, Norway.

Bjarne Hansen

Bjarne Hansen is a clinical psychologist and associate professor at the University of Bergen.

Gerd Kvale

Gerd Kvale is a professor at the University of Bergen and the leader of the OCD-Team in Helse Bergen.

Thomas Eilertsen

Thomas Eilertsen is a clinical psychologist working in Helse Vest.

Torun Grøtte

Torun Grøtte is a PhD candidate at NTNU, Trondheim, Norway.

Stian Solem

Stian Solem is an associate professor at NTNU.

The OCD-Team in Helse Bergen offers evidence based therapy to patients with OCD. The team integrates clinical practice and research and has published several papers about the four-day intensive treatment. The current paper investigates the treatment format further, investigating predictors of treatment outcome. A list of research publications can be found at https://helse-bergen.no/ocd-teamet/publications.