Exposure and Response Prevention Versus Stress Management Training for Adults and Adolescents with Obsessive Compulsive Disorder: A Randomized Clinical Trial

Overview

Journal Behav Res Ther

Specialty Psychology

Date 2023 Dec 16

PMID 38103359

Authors

Joseph A Himle

Andrew Grogan-Kaylor

Matthew A Hiller

Kristin A Mannella

Luke J Norman

James L Abelson

Aileen Prout

Angela A Shunnarah

Hannah C Becker

Stefanie R Russman Block

Stephan F Taylor

Kate D Fitzgerald

Affiliations

Soon will be listed here.

Abstract

Objective: Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT).

Methods: This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups.

Results: ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP.

Conclusion: A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.

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