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Behavioral avoidance predicts treatment outcome with exposure and response prevention for obsessive–compulsive disorder

Wheaton, Michael G. ; Gershkovich, Marina ; Gallagher, Thea ; Foa, Edna B. ; Simpson, H. Blair

Depression and Anxiety, March 2018, Vol.35(3), pp.256-263 [Peer Reviewed Journal]

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  • Title:
    Behavioral avoidance predicts treatment outcome with exposure and response prevention for obsessive–compulsive disorder
  • Author/Creator: Wheaton, Michael G. ; Gershkovich, Marina ; Gallagher, Thea ; Foa, Edna B. ; Simpson, H. Blair
  • Subjects: Avoidance ; Cognitive‐Behavioral Therapy Cbt ; Exposure And Response Prevention ; Obsessive–Compulsive Disorder Ocd ; Predictors
  • Is Part Of: Depression and Anxiety, March 2018, Vol.35(3), pp.256-263
  • Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1002/da.22720/abstract Byline: Michael G. Wheaton, Marina Gershkovich, Thea Gallagher, Edna B. Foa, H. Blair Simpson Keywords: avoidance; cognitive-behavioral therapy (CBT); exposure and response prevention; obsessive-compulsive disorder (OCD); predictors Background Many individuals with obsessive-compulsive disorder (OCD) display behavioral avoidance related to their obsessional thoughts and compulsive behaviors. However, how these avoidance behaviors impact treatment outcomes with exposure and response prevention (EX/RP) remains unclear. We examined pretreatment avoidance behaviors as predictors of EX/RP outcomes. Methods Data came from a randomized controlled trial of augmentation strategies for inadequate response to serotonin reuptake inhibitors comparing EX/RP (N = 40), risperidone (N = 40), and placebo (N = 20). Baseline avoidance was rated with the avoidance item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Primary analyses examined avoidance behaviors as predictors of EX/RP outcomes. To test specificity, we explored whether avoidance also related to outcomes among patients receiving risperidone and placebo. Results More than half (69%) of the full sample had moderate or severe avoidance behaviors at baseline. In EX/RP, controlling for baseline severity, pretreatment avoidance predicted posttreatment YBOCS symptoms ([beta] = 0.45, P < .01). Avoidant individuals were less likely to achieve remission with EX/RP (odds ratio = 0.04, 95% confidence interval [CI] range 0.01-0.28, P = .001). Baseline avoidance was also associated with degree of patient adherence to between-session EX/RP assignments, which mediated the relationship between baseline avoidance and EX/RP outcomes (P < .05). Baseline avoidance did not predict outcomes or wellness among patients receiving risperidone or placebo. Conclusions These results suggest that avoidance behaviors are an important clinical factor in EX/RP outcomes and indicate that assessing avoidance may provide an efficient method for predicting EX/RP outcomes. Avoidance may be particularly relevant in EX/RP as compared to medication treatment, though future replication of these initial results is required. Article Note: Funding information Grant sponsor: National Institute of Mental Health; Grant numbers: R01 MH045436, R01 MH45404, and K24 MH091555; Grant sponsor: New York State Office of Mental Hygiene.
  • Identifier: ISSN: 1091-4269 ; E-ISSN: 1520-6394 ; DOI: 10.1002/da.22720