TY - JOUR
T1 - Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder
AU - Simpson, Helen B.
AU - Foa, Edna B.
AU - Wheaton, Michael G.
AU - Gallagher, Thea
AU - Gershkovich, Marina
AU - Schmidt, Andrew B.
AU - Huppert, Jonathan D.
AU - Campeas, Raphael B.
AU - Imms, Patricia A.
AU - Cahill, Shawn P.
AU - DiChiara, Christina
AU - Tsao, Steven D.
AU - Puliafico, Anthony C.
AU - Chazin, Daniel
AU - Asnaani, Anu
AU - Moore, Kelly
AU - Tyler, Jeremy
AU - Steinman, Shari A.
AU - Sanchez-LaCay, Arturo
AU - Capaldi, Sandy
AU - Snorrason, Ivar
AU - Turk-Karan, Elizabeth
AU - Vermes, Donna
AU - Kalanthroff, Eyal
AU - Pinto, Anthony
AU - Hahn, Chang Gyu
AU - Xu, Bin
AU - Van Meter, Page E.
AU - Katechis, Martha
AU - Scodes, Jennifer
AU - Wang, Yuanjia
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - CBT
KW - Cognitive-behavioral therapy
KW - EX/RP
KW - Exposure and ritual prevention
KW - OCD
KW - Obsessive-compulsive disorder
UR - https://www.scopus.com/pages/publications/85107136862
U2 - 10.1016/j.brat.2021.103890
DO - 10.1016/j.brat.2021.103890
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C2 - 34089924
AN - SCOPUS:85107136862
SN - 0005-7967
VL - 143
JO - Behaviour Research and Therapy
JF - Behaviour Research and Therapy
M1 - 103890
ER -