Predictors of response to cognitive behaviour therapy for obsessive-compulsive disorder
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Response to psychological treatment for Obsessive-Compulsive Disorder (OCD) varies, and dropout and relapse rates remain troubling. However, while studies examining symptom reductions are favourable, outcomes are less encouraging when outcome is defined in terms of clinically significant change. Moreover, there is little understanding of what predicts treatment outcome. This study examined demographic, symptomatic and cognitive predictors of outcome in 79 participants undertaking individualised cognitive-behavioural therapy for OCD. After investigating differences between treatment completers and non-completers, we examined treatment response as defined by post-treatment symptom severity and clinically reliable change, as well as predictors of treatment response. Completers were less likely to present with co-morbidity. The treatment was highly efficacious irrespective of whether completer or intention-to-treat analysis was undertaken, with 58% of treatment completers considered "recovered" at post-treatment. Lower pre-treatment levels of OCD symptoms and greater perfectionism/intolerance of uncertainty were the best unique predictors of OCD severity outcomes at post-treatment. Changes in obsessional beliefs were associated with symptomatic change, although only perfectionism/intolerance of uncertainty was a significant unique predictor of post-treatment change. Recovery status was predicted only by pre-treatment OCD severity. In helping to identify those at risk for poorer outcomes, such research can lead to the development of more effective interventions.
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Research in other areas, such as anxiety disorders, has shown that using clinically significant change as an indicator of successful outcome may lead to more consistent findings.
“Furthermore, research examining predictors of clinically significant change in other areas, such as anxiety disorders, has shown that using clinically significant change as indicator of successful outcome may actually lead to more consistent findings (Kyrios, Hordern, & Fassnacht, 2015).”
From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Kyrios, Hordern, & Fassnacht, 2015
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“Previous studies that have investigated pre‐ treatment IU as a predictor of post‐treatment OCD severity have found mixed results (e.g., Kyrios et al. 2015; Pinciotti et al. 2020), perhaps indicating that other variables mediate this relationship such as comorbidities or other cognitive factors,…”
Guo, Q., Zhu, R., Zhou, H., Wang, D., & Zhang, X. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103048 · Cited by 3 · see citing works
Cheng, J. S.-C., Khalil, E., Salehi, M., Mulcahy, L. E., Xie, I. Y., Hadizadeh, H., & Grados, M. A. (2024) · Psychopathology · doi:10.1159/000535658 · Cited by 3 · see citing works
Obsessive beliefs and uncertainty in obsessive compulsive and related patients
Olivares-Olivares, P. J., Rosa‐Alcázar, Á., Martínez-Esparza, I. C., & Alcázar, A. I. R. (2022) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2022.100316 · Cited by 3 · see citing works
“The relationship between obsessive beliefs and severity of symptoms has also been pointed out, highlighting that symptomatic improvement is accompanied by more adaptive beliefs (Kyrios et al., 2015).”
BackgroundWheaton, M. G., Ward, H. E., & Pinto, A. (2022) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2022-0023 · Cited by 4 · see citing works
Bukhari, Q., Rosenfield, D., Hofmann, S. G., Gabrieli, J. D. E., & Ghosh, S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0313351 · Cited by 3 · see citing works
“For example, greater symptom severity has often been associated with better treatment outcome in obsessive-compulsive disorder [27].”
Cheng, J., Chen, Y., Liu, J., Gao, S., Ju, Y., Liu, B., Liu, Z., & Zhang, Y. (2025) · BMC Public Health · doi:10.1186/s12889-025-24119-8 · Cited by 2 · see citing works
“A study assessing the clinical treatment outcomes of obsessive-compulsory disorder (OCD) provides an empirical evidence of perfectionism as an important maintaining element in OCD [32].”
Rector, N. A., Hawley, L. L., McCabe, R. E., Rowa, K., Key, B. L., Kassardjian, K., Richter, M. A., Sittampalam, S., & Shifrin, A. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10669-z · Cited by 2 · see citing works
The self in obsessive–compulsive personality disorder
Nedeljkovic, M., Moulding, R., Kyrios, M., & Mathews, S. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781139941297.019 · Cited by 2 · see citing works
Self-citationPeeters, M., van Passel, B., Peeters, N., & Krans, J. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.5056895 · Cited by 1 · see citing works
Moulding, R., Nedeljkovic, M., Bhar, S. S., Anglim, J., Fernandez, S., & Kyrios, M. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100823 · Cited by 1 · see citing works
Self-citationPersonality Features of Obsessive-Compulsive and Related Disorders
Pinto, A., & Cowan, E. N. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.9 · Cited by 1 · see citing works
Olatunji, B. O., Cole, D. A., Mcguire, J. F., Schneider, S. C., Small, B. J., Murphy, T. K., Wilhelm, S., GELLER, D. A., & Storch, E. A. (2021) · Clinical Psychological Science · doi:10.1177/21677026211013771 · Cited by 1 · see citing works
Treatment for OCD and Their Effectiveness
Lu, D. (2024) · Lecture Notes in Education Psychology and Public Media · doi:10.54254/2753-7048/48/20231501
Voderholzer, U., Rubart, A., Kathmann, N., Staniloiu, A., Kordon, A., & Zurowski, B. (2024) · Springer eBooks · doi:10.1007/978-3-662-67878-7_6
Claus, N., Scheunemann, J., Arlt, S., Peth, J., Gallinat, J., Cludius, B., & Jelinek, L. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70027
“This is in stark contrast to previous studies showing an impeding effect of perfectionism in the treatment of different disorders (e.g., Kyrios et al. 2015; Mitchell et al. 2013; Welch et al. 2020), as well as consistent evidence for cross ‐ sectional associations between perfectionistic concerns…”
InfluentialPredictors of Therapeutic Alliance: Patient Attachment and the Personal Style of the Therapist
Palomo, N. B. B., Saúl, L. Á., & Corbella, S. (2026) · Clínica y Salud · doi:10.5093/clh2026a5
Ouellet‐Courtois, C., Bouchard, S., Giguère, C., Koszycki, D., Lavoie, M. E., & Aardema, F. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105022
Peeters, M., van Passel, B., Peeters, N., & Krans, J. (2026) · British Journal of Clinical Psychology · doi:10.1111/bjc.70052 · Cited by 1 · see citing works
“Extremely high standards in a critic mode may interfere with the patient's willingness to take risks and face uncertainties (Kyrios et al., 2015).”
Nielsen, S. K. K., Stuart, A. C., Pedersen, M. Ø., Winding, C., Rosenberg, N., Hageman, I., Jørgensen, M. B., & Vangkilde, S. (2026) · Psychotherapy Research · doi:10.1080/10503307.2026.2671186
- Authors
- Kyrios, M., Hordern, C., & Fassnacht, D. B.
- Affiliations
- Australian National University (AU)
- Corresponding author
- Kyrios, Michael
- Venue
- International Journal of Clinical and Health Psychology
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 15
- Issue
- 3
- Pages
- 181-190
- ISSN
- 1697-2600 (ISSN-L)
- PMC
- PMC6225019
- OpenAlex
- W2109490115
- Cited by
- 68
- References
- 49
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 6 · 2016: 4
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Clinical and Health Psychology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- ANU Open Research (Australian National University) (submittedVersion)
- Redalyc (Universidad Autónoma del Estado de México) (submittedVersion)
- Funders
- University of Melbourne
- 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, cognitive behavioral therapy, treatment outcome predictors, treatment discontinuation, clinically significant change, perfectionism, intolerance of uncertainty, obsessional beliefs, comorbidities
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