Abstract
BackgroundExposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome.MethodIn a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions.ResultsIn a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings.ConclusionsThe results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.
Highlights
Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD)
The results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent
We focused on exposure process variables derived from emotional processing theory (EPT) and inhibitory learning theory (ILT [22,23,24,25, 28]), and assessed different types of distress-related expectancy violation and habituation
Summary
Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Exposure and response prevention (ERP) is the treatment of first choice for obsessive-compulsive disorder (OCD) as evidence-based guidelines suggest [1, 2]. This is because exposure-based cognitive behavioral therapy. As prediction of treatment outcome by pre-treatment variables is limited, focusing on processes and mechanisms during treatment may bear good prospects for identifying additional predictors of symptom change. It has been shown that frequency of and adherence to ERP [15,16,17] is associated with outcome, suggesting that the intervention technique itself rather than non-specific variables are crucial for symptom reduction. Different strategies to augment the effects of ERP, e.g. with D-cycloserine [18, 19] or motivational interviewing [20], yielded only small effects
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