Serious negative consequences associated with exposure and response prevention for obsessive-compulsive disorder: A survey of therapist attitudes and experiences
Open accessAbstract
OBJECTIVE: Many therapists are reluctant to conduct exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Negative beliefs about the safety and tolerability of ERP are common, especially for harm-related OCD symptoms. The study examined the nature and frequency of ERP-related serious negative consequences (SNC) and therapist attitudes and experiences providing ERP for harm-related OCD. METHODS: An anonymous survey was completed by 277 therapists with experience treating OCD using ERP. Questions assessed clinical experiences of harm-related exposures, the nature of SNC, and concerns and clinical considerations regarding ERP. RESULTS: Therapist's willingness to treat harm-related OCD was high. SNCs were reported for 6 clients (per-client risk: adults 0.05%, youth 0.01%) and 13 therapists (per therapist risk 4.73%, therapist per-year risk 0.004%). Qualitative analysis identified themes relating to the conduct of treatment, specific exposure types, professional issues, and negative perceptions of ERP. CONCLUSION: SNC associated with ERP for OCD are rare and primarily represent unintended secondary consequences of OCD or misunderstandings regarding the process and rationale behind ERP. Improving access to ERP will require good communication with clients, families, and other professionals regarding the rationale and safety of ERP.
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The broad measure of side effects allows comparison of negative event rates of different therapies but prevents disentangling side effects of exposure from other treatment components and does not reveal specific side effects of exposure.
“This allows to compare negative event rates of different therapies but prevents disentangling the side effects of exposure from that of other treatment components (e.g., cognitive preparation) and does not reveal specific side effects of exposure”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Schneider et al., 2020
The paper does not describe a measure for comparing negative-event rates across different therapies. Contrary to the claim that it does not reveal specific effects of exposure, Table 2 in the Discussion describes consequences associated with particular exposure types, including a car crash during a driving exposure. The Conclusion also reports serious-negative-consequence rates by exposure type (pages unavailable in our copy). (LLM, conf=0.76)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOne recent survey examined therapist-reported severe side effects of exposure for obsessive-compulsive disorder, reported in less than 0.01% of treatments.
“One recent survey examined therapist-reported severe side effects of exposure for obsessive-compulsive disorder (Schneider et al., 2020), which were reported in less than 0.01% of treatments.”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Schneider et al., 2020
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- Authors
- Schneider, S. C., Knott, L., Cepeda, S. L., Hana, L. M., McIngvale, E., Goodman, W. K., & Storch, E. A.
- Affiliations
- Baylor College of Medicine (US)
- The Houston OCD ProgramHouston Texas
- Corresponding author
- Schneider, Sophie C.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2020-02-12
- Volume
- 37
- Issue
- 5
- Pages
- 418-428
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W3005638277
- Cited by
- 48
- References
- 31
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 7 · 2023: 5 · 2022: 11 · 2021: 3 · 2020: 6
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- 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
- exposure and response prevention, obsessive-compulsive disorder, therapist attitudes, therapist experience, treatment safety, customer communication, access to treatment
- MeSH terms
- Adolescent, Adult, Attitude, Clinical Competence, Emotions, Female, Humans, Implosive Therapy, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Obsessive-Compulsive Disorder, Physician-Patient Relations, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome
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