Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. (August 2021)

• Record Type: Journal Article
• Authors: Simpson, Helen B.; Foa, Edna B.; Wheaton, Michael G.; Gallagher, Thea; Gershkovich, Marina; Schmidt, Andrew B.; Huppert, Jonathan D.; Campeas, Raphael B.; Imms, Patricia A.; Cahill, Shawn P.; DiChiara, Christina; Tsao, Steven D.; Puliafico, Anthony C.; Chazin, Daniel; Asnaani, Anu; Moore, Kelly; Tyler, Jeremy; Steinman, Shari A.; Sanchez-LaCay, Arturo; Capaldi, Sandy; Snorrason, Ivar; Turk-Karan, Elizabeth; Vermes, Donna; Kalanthroff, Eyal; Pinto, Anthony; Hahn, Chang-Gyu; Xu, Bin; Van Meter, Page E.; Katechis, Martha; Scodes, Jennifer; Wang, Yuanjia;
• Is Part Of: Behaviour research and therapy. Volume 143(2021)
• Publication Date: 2021-08
• Subjects: Obsessive-compulsive disorder -- OCD -- Exposure and ritual prevention -- EX/RP -- Cognitive-behavioral therapy -- CBT; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2021.103890
• Languages: English
• ISSNs: 0005-7967

Abstract

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. Highlights: We tested EX/RP as an SRI augmentation strategy for adults with OCD. Extending EX/RP from 17 to 25 sessions of EX/RP enabled 69.3% of patients to achieve remission. Patient adherence, OCPD traits, and BDNF genotype influenced the odds and timing of remission.