Adding Motivational Interviewing to Exposure and Ritual Prevention for Obsessive–Compulsive Disorder: An Open Pilot Trial

Abstract

Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive–compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom‐focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information‐gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale‐Brown Obsessive Compulsive Scale [Y‐BOCS] score⩾16) underwent treatment. Five showed a decrease in their baseline Y‐BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y‐BOCS⩽12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.