Cited by 217Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder

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Simpson, Helen Blair, Maher, Michael J., Wang, Yuanjia, Bao, Yuanyuan, Foa, Edna B., Franklin, Martin·2011·Journal of Consulting and Clinical Psychology

DOI 10.1037/a0022659PMC PMC3891521

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Abstract

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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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)
ORCID: Simpson, Helen Blair
Wang, Yuanjia
Bao, Yuanyuan
Foa, Edna B.
Franklin, Martin
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2011-04
Volume: 79
Issue: 2
Pages: 247-252
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/a0022659
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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Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder

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