Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy
Open accessAbstract
OBJECTIVE: Obsessive-compulsive disorder (OCD) is associated with impaired functioning and depression. Our aim was to examine relationships between OCD symptoms, depression and functioning before and after exposure and response prevention (ERP), a type of cognitive-behavioural therapy for OCD, specifically examining whether functioning, depression and other cognitive factors like rumination and worry acted as mediators. METHODS: Forty-four individuals with OCD were randomised to 4 weeks of intensive ERP treatment first (n = 23) or waitlist then treatment (n = 21). We used a bootstrapping method to examine mediation models. RESULTS: OCD symptoms, depression and functioning significantly improved from pre- to post-intervention. Functioning mediated the relationship between OCD symptoms and depression and the relationship between functioning and depression was stronger at post-treatment. Depression mediated the relationship between OCD symptoms and functioning, but only at post-intervention. Similarly, rumination mediated the relationship between OCD symptoms and depression at post-intervention. CONCLUSIONS: Our findings suggest that after ERP, relationships between depression and functioning become stronger. Following ERP, treatment that focuses on depression and functioning, including medication management for depression, cognitive approaches targeting rumination, and behavioural activation to boost functionality may be important clinical interventions for OCD patients.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
OCD and depression share some dysfunctional beliefs and coping strategies, such as rumination.
“because OCD and depression have a lifetime comorbidity of 56.6% [61] and share some dysfunctional beliefs and coping strategies, such as rumination [62–64].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [63]
The Objective section describes rumination as important in depression and associated with OCD, and explains how beliefs in OCD can trigger rumination as a way to manage distressing thoughts. It does not establish that OCD and depression share the same dysfunctional beliefs, although it supports rumination as a process relevant to both. (LLM, conf=0.83)
Experimental — accuracy not yet measuredDepressive symptoms, especially rumination, are highly relevant as targets for patients with OCD.
“thus depressive symptoms, especially rumination [62–64], are highly relevant as targets for patients with OCD.”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [63]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(2013) · Cited by 44,563 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
The assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455 · see citing works
The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability
Goodman, W. K. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810110048007 · Cited by 7,712 · see citing works
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00088.x · Cited by 5,172 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
The Global Assessment Scale: A Procedure for Measuring Overall Severity of Psychiatric Disturbance
Endicott, J. (1976) · Archives of General Psychiatry · doi:10.1001/archpsyc.1976.01770060086012 · Cited by 4,982 · cited 1× · see citing works
“We used the Global Assessment Scale (GAS) as our measure of general functioning and social and occupational performance (Endicott et al. 1976).”
MethodRumination reconsidered: a psychometric analysis.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003) · Cognitive Therapy and Research · doi:10.1023/a:1023910315561 · Cited by 3,808 · see citing works
The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010) · Molecular Psychiatry · doi:10.1038/mp.2008.94 · Cited by 2,771 · see citing works
Hayes, A. F., & Rockwood, N. J. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.11.001 · Cited by 2,350 · see citing works
McDowell, I. (2006) · doi:10.1093/acprof:oso/9780195165678.001.0001 · Cited by 2,095 · see citing works
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., et al. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.4.658 · Cited by 1,607 · cited 1× · see citing works
“Behavioural activation is a type of behaviour therapy typically carried out in patients with unipolar depression; it is a treatment approach that focuses on increased functional activity as a strategy to reduce depressive symptoms (Dimidjian et al. 2006).”
BackgroundExplaining the gender difference in depressive symptoms.
Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.77.5.1061 · Cited by 1,543 · cited 2× · see citing works
“Higher scores indicate more rumination; scores can range from 22 to 88 and in a normative sample, mean scores on the RSS were 42 for women and 40 for men (Nolen-Hoeksema et al. 1999).”
BackgroundResultBehavioral activation treatments of depression: a meta-analysis.
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.11.001 · Cited by 1,144 · see citing works
Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample
Brown, T. A., Antony, M. M., & Barlow, D. H. (1992) · Behaviour Research and Therapy · doi:10.1016/0005-7967(92)90093-v · Cited by 812 · see citing works
Clinical characteristics and family history in DSM-III obsessive- compulsive disorder
(1986) · American Journal of Psychiatry · doi:10.1176/ajp.143.3.317 · Cited by 668 · see citing works
Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., Welton, N. J., Baxter, H., Kessler, D., Churchill, R., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30069-4 · Cited by 407 · see citing works
Cognitive-Behavioral Therapy for OCD
Clark, D. A. (2003) · Cited by 400 · see citing works
Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K., & Veale, D. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.058 · Cited by 283 · see citing works
The clinical impact of bipolar and unipolar affective comorbidity on obsessive–compulsive disorder
Perugi, G., Akiskal, H. S., Pfanner, C., Presta, S., Gemignani, A., Milanfranchi, A., Lensi, P., Ravagli, S., & Cassano, G. B. (1997) · Journal of Affective Disorders · doi:10.1016/s0165-0327(97)00075-x · Cited by 205 · see citing works
Overbeek, T., Schruers, K., Vermetten, E., & Griez, E. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n1204 · Cited by 196 · see citing works
Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD
Olatunji, B., Wolitzky-Taylor, K. B., Sawchuk, C. N., & Ciesielski, B. G. (2010) · Applied and Preventive Psychology · doi:10.1016/j.appsy.2011.03.001 · Cited by 155 · see citing works
Abramowitz, J. S. (1998) · Behavior Therapy · doi:10.1016/s0005-7894(98)80012-9 · Cited by 141 · see citing works
Romanelli, R., Wu, F. M., Gamba, R., Mojtabai, R., & Segal, J. (2014) · Depression and Anxiety · doi:10.1002/da.22232 · Cited by 124 · see citing works
Rating scales for depression and anxiety: a current perspective.
Snaith, R. P., & Taylor, C. (1985) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1985.tb02737.x · Cited by 124 · see citing works
Mastery of Obsessive-Compulsive Disorder: A Cognitive-Behavioral Approach Therapist Guide
Kozak, M. J., Foa, E. B., & Clark, D. A. (2001) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.15.3.273 · Cited by 123 · see citing works
Treatment of obsessive‐compulsive disorder in patients who have comorbid major depression
Abramowitz, J. S. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.20078 · Cited by 121 · see citing works
Obsessive-compulsive disorder with comorbid major depression: What is the role of cognitive factors?
Abramowitz, J. S., Storch, E. A., Keeley, M., & Cordell, E. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.04.003 · Cited by 107 · see citing works
Treatment of Obsessive-Compulsive Disorder by U.S. Psychiatrists
Blanco, C., Olfson, M., Stein, D. J., Simpson, H. B., Gameroff, M. J., & Narrow, W. H. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0611 · Cited by 103 · see citing works
Zandberg, L. J., Zang, Y., McLean, C. P., Yeh, R., Simpson, H. B., & Foa, E. B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.03.005 · Cited by 52 · see citing works
Feusner, J. D., Moody, T., Lai, T. M., Sheen, C., Khalsa, S., Brown, J., Levitt, J., Alger, J., & O’Neill, J. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00074 · Cited by 46 · see citing works
Self-citationCingulate and thalamic metabolites in obsessive-compulsive disorder
O’Neill, J., Lai, T. M., Sheen, C. L., Salgari, G. C., Ly, R., Armstrong, C. C., Chang, S. W., Levitt, J. G., Salamon, N., Alger, J. R., et al. (2016) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2016.05.005 · Cited by 38 · see citing works
Self-citationAssessment of obsessive–compulsive disorder: review and future directions
Benito, K., & Storch, E. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.195 · Cited by 36 · see citing works
Thomsen, P. H. (1995) · European Child & Adolescent Psychiatry · doi:10.1007/bf01977739 · Cited by 34 · see citing works
Meyer, J. M., McNamara, J. P. H., Reid, A. M., Storch, E. A., Geffken, G. R., Mason, D. M., Murphy, T. K., & Bussing, R. (2013) · Child Psychiatry & Human Development · doi:10.1007/s10578-013-0388-4 · Cited by 32 · see citing works
Treatment of Obsessive-Compulsive Disorder in a Nationwide Survey of Office-Based Physician Practice
Patel, S. R., Humensky, J. L., Olfson, M., Simpson, H. B., Myers, R., & Dixon, L. B. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300192 · Cited by 18 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Kozak MJ Foa EB 1997a Mastery of obsessive-compulsive disorder: a cognitive-behavioral approach client workbook New York Oxford University Press
Cited by
Sorted by citations
A Meta-analysis of Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder
Steuber, E. R., & Mcguire, J. F. (2023) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2023.06.003 · Cited by 41 · see citing works
Simkin, V., Hodsoll, J. P., & Veale, D. M. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101748 · Cited by 19 · see citing works
Miegel, F., Demiralay, C., Moritz, S., Wirtz, J., Hottenrott, B., & Jelinek, L. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02648-3 · Cited by 18 · see citing works
Examining depression symptoms within OCD: the role of experiential avoidance
Browning, M. E., Kirk, N. P. V., & Krompinger, J. W. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000497 · Cited by 15 · see citing works
Moritz, S., Irshaid, S., Beiner, A., Hauschildt, M., & Miegel, F. (2019) · Journal of Experimental Psychopathology · doi:10.1177/2043808718820683 · Cited by 13 · see citing works
Wang, P., Cao, W., Chen, T., Gao, J., Liu, Y., Yang, X., Meng, F., Sun, J., & Li, Z. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.755159 · Cited by 13 · see citing works
Hühne, V., Chacur, C., de Oliveira, M. V. S., Fortes, P. P., de Menezes, G. M. B., & Fontenelle, L. F. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2265066 · Cited by 11 · see citing works
Berman, N. C., Hezel, D. M., & Wilhelm, S. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101615 · Cited by 10 · see citing works
The effects of depression on the treatment of OCD in a residential sample
Wetterneck, C. T., Leonard, R. C., Adams, T. G., Riemann, B. C., Grau, P. P., & Franklin, M. E. (2020) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2020.84.suppa.12 · Cited by 9 · see citing works
Moritz, S., Bernardini, J., & Lion, D. (2020) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-019-01080-3 · Cited by 7 · see citing works
Predictors of Intensive Treatment in Patients With Obsessive-Compulsive Disorder
du Mortier, J. A. M., Remmerswaal, K. C. P., Batelaan, N. M., Visser, H. A. D., Twisk, J. W. R., van Oppen, P., & van Balkom, A. J. L. M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.659401 · Cited by 7 · see citing works
Tadayonnejad, R., Corlier, J., Valles, T. E., Citrenbaum, C., Matthews, C. D., Einstein, E. H., Wilke, S. A., Slan, A. R., Distler, M. G., Hoftman, G. D., et al. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.09.026 · Cited by 6 · see citing works
Self-citationThe Relationship between OCD and Depression in Adults: A Review of Recent Findings
Pastre, M., Raffard, S., Mallet, L., & López‐Castromán, J. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01589-6 · Cited by 9 · see citing works
Smárason, O., Boedeker, P., Guzick, A. G., Tendler, A., Sheth, S. A., Goodman, W. K., & Storch, E. A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.075 · Cited by 6 · see citing works
Algin, S., Banik, D., Rahman, S. A., Tusher, S. M., Johora, F. T., Akter, A., Ahmed, T., Biswas, M. A. M., Sinha, S., & Haque, M. (2024) · Cureus · doi:10.7759/cureus.57877 · Cited by 3 · see citing works
Improv Intervention for Obsessive-Compulsive Symptoms: A Pilot Study from Turkey
Kozak, E. D., Halimoğlu, G., & Kavakçı, Ö. (2024) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2024.2319825 · Cited by 3 · see citing works
Dehkordi, F. J., Farani, A. R., Gharraee, B., Shati, M., & Ashouri, A. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_324_22 · Cited by 2 · see citing works
Remmerswaal, K. C. P., Batelaan, N. M., van Oppen, P., Scholten, W., & van Balkom, A. J. L. M. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000796 · Cited by 1 · see citing works
Ponzini, G. T., Hundt, N. E., Christie, I. C., Chen, P. V., Ecker, A. H., Lindsay, J. A., Teng, E. J., Storch, E. A., Myers, U. S., Roussev, M. S., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107445
The Effects of Metacognition on Social Functioning in Patients With Obsessive-Compulsive Disorder
Kul, A. T., Uğurlu, G. K., & Gündoğmuş, İ. (2024) · Psychiatric Annals · doi:10.3928/00485713-20240131-01 · Cited by 1 · see citing works
Pogue, E. D., & Edelstein, M. L. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.02.003
van Passel, B., Danner, U. N., Dingemans, A. E., Broekman, T. G., Sternheim, L. C., Becker, E. S., Elburg, A. A. V., van Furth, E. F., Hendriks, G., & Cath, D. C. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1456890 · Cited by 1 · see citing works
Evaluation of obsessive-compulsive disorder in cancer patients: A case–control study
İnci, F., & İnci, H. (2024) · Indian Journal of Cancer · doi:10.4103/ijc.ijc_1413_20
Yong, M., Fang, A., & McCarty, C. A. (2026) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2026.100179
Deb, D., Malhotra, S., Arya, A., & Ajanya, A. K. (2026) · Annals of Indian Psychiatry · doi:10.4103/aip.aip_292_26
- Authors
- Motivala, S. J., Arellano, M., Greco, R. L., Aitken, D., Hutcheson, N., Tadayonnejad, R., O’Neill, J., & Feusner, J. D.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Motivala, Sarosh J.
- Venue
- International Journal of Psychiatry in Clinical Practice
- Publisher
- Informa UK Limited
- Published
- 2017-07-25
- Volume
- 22
- Issue
- 1
- Pages
- 40-46
- ISSN
- 1365-1501 (ISSN-L)
- 1471-1788
- PMC
- PMC5777899
- OpenAlex
- W2725702475
- Cited by
- 25
- References
- 36
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 8 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-09-26)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Psychiatry in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH085900)
- 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, depression, functioning, exposure and response prevention, rumination, worry, mediation, behavioral activation, cognitive behavioral therapy
- MeSH terms
- Rumination, Cognitive, Adult, Depression, Female, Humans, Implosive Therapy, Male, Middle Aged, Obsessive-Compulsive Disorder, Cognitive Behavioral Therapy, Outcome Assessment, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
