Who profits from concentrated exposure treatment for Obsessive-Compulsive Disorder (OCD)? A quality assurance project from the OCD-team in Bergen

Abstract

Obsessive-Compulsive Disorder (OCD) is a debilitating psychological disorder characterized by bothersome and intrusive thoughts (obsessions) associated with anxiety and distress that the patient tries to reduce or control through compulsive behavior. The main recommended treatment for OCD is Cognitive behavioral therapy (CBT), including exposure and response prevention (ERP). At the OCD-team in Bergen, Norway, ERP is offered in a concentrated treatment format across four consecutive days. However, not all patients profit from ERP treatment, and it is an important task to establish which patients respond to this treatment and who does not. This thesis set out to investigate whether the concentrated treatment works for patients with certain characteristics. In paper I, we examined the relationship between treatment outcome and hardiness or resilience; a personality trait regarding sense of meaning and commitment, locus of control, and preferences for challenges. In paper II, we explored the relationship between treatment outcome and the personality trait sensory processing sensitivity. In the paper III, we investigated whether post-treatment levels of depression, anxiety and OCD were related to treatment outcome. We report on data from a quality assurance database at an outpatient OCD-clinic in Bergen, Norway. The quality assurance database was established during the national implementation of publicly available ERP treatment in Norway in order to monitor the treatment delivered by specialized OCD-teams. Symptoms were measured pre- and post-treatment, and at 3-6 month follow-up. The concentrated treatment was found to be highly effective, and the majority of patients had a clinically significant and lasting improvement in OCD symptoms. No adverse effects were detected. Results showed that the treatment was equally efficient for patients scoring high and low on resilience and sensory processing sensitivity. This is an important finding, as research suggest that therapists might be reluctant to offer exposure treatment to patients considered too “fragile” or “sensitive” for exposure tasks. However, the combination of subclinical levels of depression, anxiety, and OCD symptoms at post-treatment was associated with higher levels of OCD-symptoms at follow-up. This is in line with previous research, and points to the importance of full recovery post-treatment. We recommend clinicians to pay attention to patients with residual symptoms to reduce risk of relapse. We also recommend clinicians to offer evidence based ERP treatment to patients regardless of scores on sensitivity and resilience. Important limitations in the current thesis include the reliance on self-report data, whether our results can be generalized to other treatment formats, and the lack of other possibly relevant predictor variables. We recommend future studies to investigate whether our findings hold true in other samples and treatment formats. We argue that quality assurance as an integrated part of treatment provides safety for the patients and a unique opportunity for improvements and continued development of evidence based treatments.