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Cited by 56Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

Behavioral avoidance predicts treatment outcome with exposure and response prevention for obsessive-compulsive disorder

Open access
Wheaton, Michael G., Gershkovich, Marina, Gallagher, Thea, Foa, Edna B., Simpson, H. Blair·2018·Depression and Anxiety
DOI 10.1002/da.22720PMC PMC6945296
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Abstract

BACKGROUND: Many individuals with obsessive-compulsive disorder (OCD) display behavioral avoidance related to their obsessional thoughts and compulsive behaviors. However, how these avoidance behaviors impact treatment outcomes with exposure and response prevention (EX/RP) remains unclear. We examined pretreatment avoidance behaviors as predictors of EX/RP outcomes. METHODS: Data came from a randomized controlled trial of augmentation strategies for inadequate response to serotonin reuptake inhibitors comparing EX/RP (N = 40), risperidone (N = 40), and placebo (N = 20). Baseline avoidance was rated with the avoidance item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Primary analyses examined avoidance behaviors as predictors of EX/RP outcomes. To test specificity, we explored whether avoidance also related to outcomes among patients receiving risperidone and placebo. RESULTS: More than half (69%) of the full sample had moderate or severe avoidance behaviors at baseline. In EX/RP, controlling for baseline severity, pretreatment avoidance predicted posttreatment YBOCS symptoms (β = 0.45, P < .01). Avoidant individuals were less likely to achieve remission with EX/RP (odds ratio = 0.04, 95% confidence interval [CI] range 0.01-0.28, P = .001). Baseline avoidance was also associated with degree of patient adherence to between-session EX/RP assignments, which mediated the relationship between baseline avoidance and EX/RP outcomes (P < .05). Baseline avoidance did not predict outcomes or wellness among patients receiving risperidone or placebo. CONCLUSIONS: These results suggest that avoidance behaviors are an important clinical factor in EX/RP outcomes and indicate that assessing avoidance may provide an efficient method for predicting EX/RP outcomes. Avoidance may be particularly relevant in EX/RP as compared to medication treatment, though future replication of these initial results is required.

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  • Avoidance plays a key role in clinical outcomes.

    “In addition to its apparent independence from fear, avoidance also plays a key role in clinical outcomes (typically measured using self-report symptom questionnaires).”

    From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Wheaton, Gershkovich, Gallagher, Foa, & Simpson, 2018

    The Conclusions report that pretreatment avoidance predicted poorer exposure and response prevention (EX/RP) outcomes in adults with OCD. The claim is broader than the finding: the paper says the result was preliminary and did not extend to the risperidone or placebo groups. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Higher rates of pre-treatment avoidance are related to poorer outcomes in obsessive-compulsive disorder and social anxiety disorder.

    “Higher rates of pre-treatment avoidance have been related to poorer outcomes in obsessive-compulsive disorder (Wheaton, Gershkovich, Gallagher, Foa, & Simpson, 2018) and social anxiety disorder (Mesri et al., 2017)”

    From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Wheaton, Gershkovich, Gallagher, Foa, & Simpson, 2018

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Research works printed but not linked: 26

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Cited by

Sorted by citations

Authors
Wheaton, M. G., Gershkovich, M., Gallagher, T., Foa, E. B., & Simpson, H. B.
Affiliations
  • New York State Psychiatric Institute (US)
  • University of Pennsylvania (US)
Corresponding author
Simpson, H. Blair
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2018-02-02
Volume
35
Issue
3
Pages
256-263
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22720
PMC
PMC6945296
OpenAlex
W2790186419
Cited by
56
References
14
Citations by year
2026: 11 · 2025: 7 · 2024: 9 · 2023: 3 · 2022: 12 · 2021: 5 · 2020: 6 · 2019: 2 · 2018: 1
FWCI
3.90
Type
journal article
Language
en
Open access
Licence
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01 MH045436, R01 MH45404, K24 MH091555)
  • New York State Office of Mental Hygiene
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, behavioral avoidance, exposure and response prevention, treatment outcome prediction, risperidone, serotonin reuptake inhibitors, medication adherence, remission, obsessions and compulsions
MeSH terms
Adolescent, Adult, Aged, Avoidance Learning, Female, Humans, Implosive Therapy, Male, Middle Aged, Obsessive-Compulsive Disorder, Outcome Assessment, Health Care, Young Adult

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