Abstract
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients' ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.
Highlights
Exposure and response prevention (ERP) is a highly effective treatment for obsessive-compulsive disorder (OCD) (1)
The Behavioral Avoidance Test (BAT) discomfort scores were significantly correlated with the OCD severity measure of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (r = 0.39, p = 0.045), but not with the measure of Padua Inventory-Palatine Revision (PI-PR) (r = 0.32, p = 0.118)
After entering Y-BOCS pretreatment score in step 1 in the regression analyses, the additional block of BAT pretreatment scores of avoidance was predictive of Y-BOCS posttreatment outcome ( r2 = 0.17, p = 0.028) as well as Y-BOCS follow-up outcome on trend level ( r2 = 0.11, p = 0.097), with higher BAT avoidance being related to higher Y-BOCS posttreatment/followup outcome
Summary
Exposure and response prevention (ERP) is a highly effective treatment for obsessive-compulsive disorder (OCD) (1). One supposed mechanism of change is the experience of habituation with a significant reduction of anxiety and discomfort levels while stopping avoidance and rituals in OCD-relevant situations (2). The BAT has rarely been used to investigate individual behavior-related changes during ERP as well as its predictive value for treatment outcome in OCD. The BAT asks patients to rate avoidance, rituals and discomfort during the stepwise exposure to three OCD-relevant situations. By using individual relevant OCD situations and steps for exposure, the BAT accounts for the idiosyncratic nature of OCD. The study by Steketee et al (3) investigated the relationship of the BAT to measures of OCD symptom severity and found moderate correlations. Due to the different methodological approach, further investigation of the relationship of the BAT to therapist- and self-rated OCD severity seems to be necessary
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