Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Clara Strauss,Laura Lea,Mark Hayward,Elizabeth Forrester,Tamara Leeuwerik,Anna-Marie Jones,Claire Rosten

doi:10.1016/j.janxdis.2018.04.007

Abstract

BackgroundOnly about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. MethodsThis was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. ResultsBoth groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP – the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. ConclusionsMB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

Highlights

Obsessive compulsive disorder (OCD) is characterised by persistent intrusive thoughts that cause significant anxiety and repetitive behaviours aimed at neutralising anxiety or preventing a dreaded event (American Psychiatric Association, 2013)
37 participants were randomised to an MB-exposure and response prevention (ERP) (n = 19) or ERP (n = 18) group
Underpowered to draw definitive conclusions, findings from this pilot randomised controlled trial (RCT) suggest that adding a brief mindfulness-based intervention to ERP may not lead to clinically meaningful improvements in obsessive compulsive disorder (OCD) symptom severity outcomes compared to ERP alone

Summary

Introduction

Obsessive compulsive disorder (OCD) is characterised by persistent intrusive thoughts that cause significant anxiety and repetitive behaviours aimed at neutralising anxiety or preventing a dreaded event (American Psychiatric Association, 2013). Practice guidelines recommend exposure and response prevention (ERP), delivered with or without cognitive therapy, as the psychological therapy for OCD (American Psychiatric Association, 2007; National Institute of Health and Care Excellence [NICE], 2005). Simpson et al. Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP – the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conclusions: MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility

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