Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder
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OBJECTIVE: To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). METHOD: Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory sessions and 15 exposure sessions. Because there were no significant group differences in adherence or outcome, the groups were combined to examine the effects of patient adherence on outcome. Independent evaluators assessed OCD severity using the Yale-Brown Obsessive Compulsive Scale. Therapists assessed patient adherence to between-session EX/RP assignments at each session using the Patient EX/RP Adherence Scale (PEAS). Linear regression models were used to examine the effects of PEAS scores on outcome, adjusting for baseline severity. The relationship between patient adherence and other predictors of outcome was explored using structural equation modeling. RESULTS: Higher average PEAS ratings significantly predicted lower posttreatment OCD severity in intent-to-treat and completer samples. PEAS ratings in early sessions (5-9) also significantly predicted posttreatment OCD severity. The effects of other significant predictors of outcome in this sample (baseline OCD severity, hoarding subtype, and working alliance) were fully mediated by patient adherence. CONCLUSIONS: Patient adherence to between-session EX/RP assignments significantly predicted treatment outcome, as did early patient adherence and change in early adherence. Patient adherence mediated the effects of other predictors of outcome. Future research should develop interventions that increase adherence and then test whether increasing adherence improves outcome. If effective, these interventions could then be used to personalize care.
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Patient adherence to treatment is a known predictor of EX/RP response.
“as patient treatment adherence is a known predictor of EX/RP response (27)”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [27]
Adherence to treatment is a leading known predictor of how well patients respond to EX/RP.
“Treatment adherence is among the strongest known predictors of EX/RP response (27)”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [27]
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Gershkovich, M., Middleton, R., Hezel, D. M., Grimaldi, S. J., Renna, M. E., Basaraba, C. N., Patel, S. R., & Simpson, H. B. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.05.001 · Cited by 27 · see citing works
Self-citationMetacognitive Training for Obsessive-Compulsive Disorder: A randomized controlled trial
Miegel, F. S., Moritz, S., Hottenrott, B., Demiralay, C., & Jelinek, L. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100647 · Cited by 27 · see citing works
Management of Treatment-Resistant Obsessive-Compulsive Disorder
Gershkovich, M., Wheaton, M. G., & Simpson, H. B. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0127-8 · Cited by 28 · see citing works
Self-citationA conceptual framework for a neurophysiological basis of art therapy for PTSD
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Self-citationClinical Feedback About Empirically Supported Treatments for Obsessive‐Compulsive Disorder
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Ojalehto, H. J., Abramowitz, J. S., Hellberg, S. N., Buchholz, J. L., & Twohig, M. P. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102210 · Cited by 25 · see citing works
Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder
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Innovations in the delivery of exposure and response prevention for obsessive-compulsive disorder
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Marker, I., Salvaris, C. A., Thompson, E. M., Tolliday, T., & Norton, P. J. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10014-1 · Cited by 23 · see citing works
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Sookman, D., Phillips, K. A., Anholt, G. E., Bhar, S. S., Bream, V., Challacombe, F. L., Coughtrey, A. E., Craske, M. G., Foa, E. B., Gagné, J.-P., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113752 · Cited by 22 · see citing works
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Tjelle, K., Opstad, H. B., Solem, S., Launes, G., Hansen, B. K. A., Kvale, G., & Hagen, K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.667167 · Cited by 21 · see citing works
The development and validation of the Memory Support Rating Scale.
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Treatment Resistance in Obsessive-Compulsive Disorder
Middleton, R., Wheaton, M. G., Kayser, R., & Simpson, H. B. (2019) · Treatment Resistance in Psychiatry · doi:10.1007/978-981-10-4358-1_11 · Cited by 19 · see citing works
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Collaborative Empiricism: A Cognitive Response to Exposure Reluctance and Low Distress Tolerance
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Self-citationAppetitive Needs and Addiction
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Klein, A., Hagen, A., Mobach, L., Zimmermann, R., Baartmans, J. M. D., Rahemenia, J., de Gier, E., Schneider, S., & Ollendick, T. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00476-5 · Cited by 12 · see citing works
- Authors
- Simpson, H. B., Maher, M. J., Wang, Y., Bao, Y., Foa, E. B., & Franklin, M.
- Affiliations
- Columbia University (US)
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2011-04
- Volume
- 79
- Issue
- 2
- Pages
- 247-252
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3891521
- OpenAlex
- W1987664345
- Cited by
- 217
- References
- 28
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 13 · 2023: 13 · 2022: 14 · 2021: 13 · 2020: 60 · 2019: 11 · 2018: 12 · 2017: 9 · 2016: 9 · 2015: 15 · 2014: 10 · 2013: 11 · 2012: 7
- FWCI
- 9.64
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34 MH071570)
- National Alliance for Research on Schizophrenia and Depression
- 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, patient adherence, exposure and response prevention, cognitive behavioral therapy, motivational interviewing, treatment outcomes, prognostic factors, mediation, therapeutic relationship, Yale-Brown Obsessive Compulsive Scale
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Motivation, Obsessive-Compulsive Disorder, Patient Compliance, Severity of Illness Index, Cognitive Behavioral Therapy, Linear Models, Treatment Outcome
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