Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder

Kristian Tjelle; Håvard Berg Opstad; Stian Solem; Gerd Kvale; Michael G Wheaton; Thröstur Björgvinsson; Bjarne Hansen; Kristen Hagen

doi:10.1186/s12888-024-05780-6

Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder

BMC Psychiatry. 2024 Apr 30;24(1):327. doi: 10.1186/s12888-024-05780-6.

Authors

Kristian Tjelle^{1

2}, Håvard Berg Opstad^{1

2}, Stian Solem^{2

3}, Gerd Kvale^{3

4}, Michael G Wheaton⁵, Thröstur Björgvinsson⁶, Bjarne Hansen^{3

7}, Kristen Hagen^{8

9

10}

Affiliations

¹ Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway.
² Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
³ Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Clinical Psychology, University of Bergen, Bergen, Norway.
⁵ Department of Psychology, Barnard College, New York, NY, 10027, USA.
⁶ Behavioral Health Partial Hospital Program, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
⁷ Department of Psychosocial Sciences, University of Bergen, Bergen, Norway.
⁸ Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway. kristen.hagen@helse-mr.no.
⁹ Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway. kristen.hagen@helse-mr.no.
¹⁰ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. kristen.hagen@helse-mr.no.

Abstract

Background: Exposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed.

Method: The present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients' treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators.

Results: PEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up.

Conclusions: These results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients.

Trial registration: ClinicalTrials.gov identifier: NCT02656342.

Keywords: Adherence; B4DT; Difficult-to-treat; ERP; Group; OCD; Work- and social functioning; cET.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Follow-Up Studies
Humans
Implosive Therapy* / methods
Male
Middle Aged
Obsessive-Compulsive Disorder* / therapy
Patient Compliance*
Severity of Illness Index
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02656342