Patient adherence and treatment outcome with exposure and response prevention for OCD: Which components of adherence matter and who becomes well?
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Exposure and response prevention (EX/RP) is an evidence-based treatment for obsessive-compulsive disorder (OCD), yet not all patients achieve wellness with EX/RP. The degree to which patients adhere to EX/RP procedures outside of sessions has been found to predict therapy outcomes, including who achieves post-treatment wellness. We sought to investigate which components of treatment adherence most relate to outcome and to develop adherence benchmarks to identify who does and does not become well to provide clinicians with prognostic tools. Adherence data came from 37 adult patients with DSM-IV OCD who received 17 sessions of EX/RP as part of a randomized controlled trial of augmentation strategies for incomplete response to serotonin reuptake inhibitors (SRIs). Therapists rated between-session patient adherence at each exposure session by quantifying: 1) the quantity of homework exposures attempted; 2) the quality of attempted exposures; and 3) the degree of success with response prevention. Each adherence item significantly correlated with post-treatment OCD severity. Success with response prevention proved particularly strongly linked to therapy outcome. Time course analysis of this item accurately identified, relatively early in treatment, who would achieve post-treatment wellness. These data provide an efficient method for differentiating between those patients who will and will not achieve wellness after EX/RP augmentation of SRIs. Limitations and clinical implications of the current findings are discussed.
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Following through with assigned exposures (treatment adherence) is associated with improved outcomes.
“Research has shown that following through with assigned exposures (i.e., treatment adherence) is associated with improved outcomes (Wheaton et al., 2016), but this fails to capture the internal stance of the patient.”
From How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder (2017) · cites this paper as Wheaton et al., 2016
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- Authors
- Wheaton, M. G., Galfalvy, H., Steinman, S. A., Wall, M. M., Foa, E. B., & Simpson, H. B.
- Affiliations
- Yeshiva University (US)
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- Corresponding author
- Simpson, H. Blair
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 85
- Pages
- 6-12
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC5031484
- OpenAlex
- W2501249616
- Cited by
- 79
- References
- 35
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 12 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 4
- FWCI
- 8.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (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 › Psychotherapy Techniques and Applications
- Keywords
- obsessive-compulsive disorder, exposure and response prevention, medication adherence, homework compliance, response prevention, treatment outcome prediction, serotonin reuptake inhibitors, augmentation strategies, prognostic factors
- MeSH terms
- Adolescent, Adult, Aged, Combined Modality Therapy, Female, Humans, Implosive Therapy, Male, Middle Aged, Obsessive-Compulsive Disorder, Patient Compliance, Antipsychotic Agents, Cognitive Behavioral Therapy, Treatment Outcome, Risperidone, Young Adult
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