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Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD

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Abstract

Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 12.9 years, 49 % male, 63 % Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.

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Notes

  1. Due to therapists not fully completing the Session Summary Sheet, there were missing values for initial distress (1 participant), decrease in distress across tasks within session through mid-treatment (1 participant), between-session decrease in distress through mid-treatment (4 participants) and post-treatment (2 participants), variability in distress through post-treatment (1 participant), and final distress through mid-treatment (6 participants) and post-treatment (3 participants). In addition, across the full sample a total of 39 sessions did not include ERP or associated therapist ratings. Twenty-two of these cases occurred in Sessions 3–11, and the majority were isolated sessions in which treatment focused on mastering associated skills (e.g., cognitive restructuring). The other 17 cases occurred in Session 12, in which treatment focused instead on relapse prevention.

  2. Due to participants who completed one ERP task per session in all sessions, decrease in distress across tasks within session and variability in distress values were coded as missing through mid-treatment (4 participants) and post-treatment (3 participants).

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Acknowledgments

This research was supported by grants from the International Obsessive Compulsive Foundation (Dr. Peris), a NARSAD Young Investigator Award (Dr. Peris), and the National Institute of Mental Health (NIMH Grant K32 MH 085058, Dr. Peris). The authors wish to acknowledge the study research team and the children and families who participated in this research. Additional disclosures: Dr. Kircanski has received research support from NIMH (NIMH Grant F32 MH 096385) and the Brain & Behavior Research Foundation (Young Investigator Award).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Psychology, Stanford University, Jordan Hall, Building 420, Stanford, CA, 94305-2130, USA

    Katharina Kircanski

  2. Division of Child and Adolescent Psychiatry, UCLA-Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA

    Tara S. Peris

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  1. Katharina Kircanski
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Correspondence to Katharina Kircanski.

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Kircanski, K., Peris, T.S. Exposure and Response Prevention Process Predicts Treatment Outcome in Youth with OCD. J Abnorm Child Psychol 43, 543–552 (2015). https://doi.org/10.1007/s10802-014-9917-2

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