Category: Obsessive Compulsive and Related Disorders

Symposium

Study of the Mechanisms of Exposure Therapy for Obsessions: Gradual Versus Variable Exposure Intensity

Friday, November 17
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: OCD (Obsessive Compulsive Disorder) | ERP (Exposure and Response Prevention) | Translational Research
Presentation Type: Symposium

Despite the efficacy of exposure and response prevention for obsessive-compulsive disorder (OCD), patients who primarily experience obsessions are at heightened risk of relapse (Williams et al., 2013). Although translational research on inhibitory learning suggests that learning to tolerate varying levels of fear during exposure enhances long-term outcomes for some anxiety-related problems (Lang & Craske, 2000), no studies have examined this in the treatment of primary obsessions. In the current study, participants with a moderately distressing obsessional thought (N = 40) were randomly assigned to either: (a) gradual exposure emphasizing fear reduction (EXP-G), or (b) variable exposure emphasizing variability in exposure intensity (EXP-V). Both groups completed four twice-weekly exposure sessions in which subjective and physiological (i.e., heart rate, skin conductance) indices of fear were collected. An independent evaluator administered clinical interview (i.e., Yale-Brown Obsessive Compulsive Scale [Y-BOCS]), self-report (i.e., Dimensional Obsessive Compulsive Scale [DOCS]), and behavioral (i.e., Behavioral Approach Task [BAT]) outcome measures at pre-treatment (PRE), post-treatment (POST), and 3-month follow-up (3MFU). In a multi-level model, both EXP-G and EXP-V interventions were associated with significant decreases in Y-BOCS, DOCS, and BAT scores from PRE to POST with large effect sizes (ps < .002, dsrange 0.88 – 1.40); however, there were no significant differences in PRE/POST changes between the two groups (ps> .36). While individuals in the EXP-G group maintained their treatment gains at 3MFU, the EXP-V group continued to significantly improve from POST to 3MFU as measured by Y-BOCS and DOCS (ps< .03); however, differences in POST to 3MFU changes between the two groups only approached significance (ps> .056). In contrast to previous studies, variability in subjective and physiological fear generally did not predict treatment outcomes. Results indicate that random/variable exposure warrants future study. Next steps for understanding the mechanisms, moderators, and implications of this novel approach will be discussed.

Ryan J. Jacoby

Post-Doctoral Fellow
Massachusetts General Hospital/Harvard Medical School; University of North Carolina at Chapel Hill

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