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Treatment Response, Symptom Remission, and Wellness in Obsessive-Compulsive Disorder
Open accessAbstract
BACKGROUND: Obsessive-compulsive disorder (OCD) is defined both by intrusive, unwanted thoughts, images, or impulses and by repetitive behavioral or mental acts that are often performed to try to alleviate anxiety. The ultimate goal of treatment for OCD is to reduce the symptoms as well as help patients achieve "wellness." Currently, however, there are no widely accepted, empirically supported criteria for determining wellness in OCD. METHOD: Building on previous research, the current study examined the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score that most reliably identified patients who responded to treatment, those who achieved symptom remission, and those who achieved wellness. The current study pooled data from 4 randomized controlled OCD treatment trials (N = 288), which took place between 1990 and 2011 at 2 academic sites. Participants (mean age = 36.8 years) had a primary diagnosis of DSM-IV-TR OCD (mean Y-BOCS score = 25.9). RESULTS: Signal detection analyses showed that a pretreatment-to-posttreatment reduction of ≥ 35% on the Y-BOCS was most predictive of treatment response as defined by the Clinical Global Impressions (CGI)-Improvement scale. A posttreatment Y-BOCS score of ≤ 14 was the best predictor of symptom remission, whereas a score of ≤ 12 was the best predictor of wellness, as defined by symptom remission (defined by the CGI-Severity scale), good quality of life (as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire), and a high level of adaptive functioning (as assessed by the Social Adjustment Scale-Self-Report). Because efficiency (0.86) and specificity (0.88) were highest at the cutoff of ≤ 12, this cutoff score was determined to be the best indicator of wellness. CONCLUSIONS: The present findings support the convergent validity of the Y-BOCS with other measures of well-being (quality of life, adaptive functioning) and highlight the utility of a Y-BOCS score ≤ 12 as a solo indicator of wellness in outcome studies. The use of empirically supported criteria for defining wellness in OCD is recommended to facilitate comparisons across treatment outcome studies and to inform clinical treatment planning. TRIAL REGISTRATION: Pooled data analyzed in this study were from 4 clinical trials, 3 of which are registered at ClinicalTrials.gov (identifiers: NCT00045903, NCT00389493, NCT00316316).
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“On the one hand, 75–80% of patients with OCD respond to ERP (reduction of ≥35% of the Y-BOCS score), but, on the other hand, only 40–73% achieve remission (depending on the definition of a Y-BOCS score ≤ 14 or ≤ 12) [21–23].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [22]
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“this cutoff not only reflects minimal symptoms after treatment but also predicts good quality of life and adaptive functioning (12,26,30).”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [30]
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“operationalized as a posttreatment Y-BOCS score ≤ 12, given that this cutoff reflects symptom reduction and predicts good quality of life and adaptive functioning (12,26,30).”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [30]
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Metadata
- Authors
- Farris, S. G., McLean, C. P., Van Meter, P. E., Simpson, H. B., & Foa, E. B.
- Affiliations
- University of Pennsylvania (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Farris, Samantha G.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2013-07-15
- Volume
- 74
- Issue
- 07
- Pages
- 685-690
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC3959901
- OpenAlex
- W1979431943
- Cited by
- 216
- References
- 33
- Citations by year
- 2026: 17 · 2025: 16 · 2024: 19 · 2023: 10 · 2022: 20 · 2021: 23 · 2020: 21 · 2019: 21 · 2018: 11 · 2017: 10 · 2016: 22 · 2015: 16 · 2014: 9 · 2013: 1
- FWCI
- 17.80
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH-04504-19, K24MH091555, R01MH045404, R34MH071570, K23MH001907, K23 MH-01907, MH-04504-05A2, R01MH045436, MH-04504-10A1, R01MH-45436)
- 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, treatment response, symptom remission, wellness, Yale-Brown Obsessive Compulsive Scale, cut-off values, quality of life, adaptive behavior, convergent validity, treatment outcome measures, signal detection analysis, Clinical Global Impression Scale, treatment planning
- MeSH terms
- Adaptation, Psychological, Adult, Female, Health Status Indicators, Humans, Male, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Psychotropic Drugs, Quality of Life, Remission Induction, Research Design, Sensitivity and Specificity, Reproducibility of Results, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders
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