Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy

Abstract

Objective: Obsessive-compulsive disorder (OCD) is associated with impaired functioning and depression. Our aim was to examine relationships between OCD symptoms, depression and functioning before and after exposure and response prevention (ERP), a type of cognitive-behavioural therapy for OCD, specifically examining whether functioning, depression and other cognitive factors like rumination and worry acted as mediators.

Methods: Forty-four individuals with OCD were randomised to 4 weeks of intensive ERP treatment first (n = 23) or waitlist then treatment (n = 21). We used a bootstrapping method to examine mediation models.

Results: OCD symptoms, depression and functioning significantly improved from pre- to post-intervention. Functioning mediated the relationship between OCD symptoms and depression and the relationship between functioning and depression was stronger at post-treatment. Depression mediated the relationship between OCD symptoms and functioning, but only at post-intervention. Similarly, rumination mediated the relationship between OCD symptoms and depression at post-intervention.

Conclusions: Our findings suggest that after ERP, relationships between depression and functioning become stronger. Following ERP, treatment that focuses on depression and functioning, including medication management for depression, cognitive approaches targeting rumination, and behavioural activation to boost functionality may be important clinical interventions for OCD patients.

Keywords:

• Cogntive-behavioural therapy
• obsessive-compulsive disorder
• mediation
• global functioning
• depression

View correction statement:

Correction to: Motivala et al., Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy

Acknowledgements

The authors would like to thank Courtney Sheen for her diligence in handling administrative responsibilities associated with this project and Michelle Massi and Natalie Abrahami for their excellent work as the treating therapists on this study.

Disclosure statement

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Additional information

Funding

This work was supported by the National Institute of Mental Health, R01MH085900 to Dr. O'Neill and Dr. Feusner.