Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder

Helen B. Simpson*, Edna B. Foa, Michael G. Wheaton, Thea Gallagher, Marina Gershkovich, Andrew B. Schmidt, Jonathan D. Huppert, Raphael B. Campeas, Patricia A. Imms, Shawn P. Cahill, Christina DiChiara, Steven D. Tsao, Anthony C. Puliafico, Daniel Chazin, Anu Asnaani, Kelly Moore, Jeremy Tyler, Shari A. Steinman, Arturo Sanchez-LaCay, Sandy CapaldiIvar Snorrason, Elizabeth Turk-Karan, Donna Vermes, Eyal Kalanthroff, Anthony Pinto, Chang Gyu Hahn, Bin Xu, Page E. Van Meter, Martha Katechis, Jennifer Scodes, Yuanjia Wang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.

Original languageAmerican English
Article number103890
JournalBehaviour Research and Therapy
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Ltd


  • CBT
  • Cognitive-behavioral therapy
  • EX/RP
  • Exposure and ritual prevention
  • OCD
  • Obsessive-compulsive disorder


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