Monnica T Williams1, Samantha G Farris2, Eric N Turkheimer3, Martin E Franklin2, H Blair Simpson4, Michael Liebowitz5, Edna B Foa2. 1. University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA. Electronic address: m.williams@louisville.edu. 2. University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA. 3. University of Virginia, Department of Psychology, 102 Gilmer Hall, Box 400400, Charlottesville, VA 22904, USA. 4. Columbia University, Department of Psychiatry, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY 10032, USA; New York State Psychiatric Institute, Division of Clinical Therapeutics, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA. 5. Columbia University, Department of Psychiatry, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY 10032, USA.
Abstract
OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. METHOD: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. RESULTS: The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β=.27, p=.02) and hoarding dimensions (β=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. CONCLUSIONS: EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
OBJECTIVE:Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCDpatients. METHOD: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. RESULTS: The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β=.27, p=.02) and hoarding dimensions (β=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. CONCLUSIONS: EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
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