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There is an imbalance between goal-directed and habitual-learning system in patients with obsessive-compulsive disorder (OCD). At present, the relationship between cognitive behavior therapy (CBT) as a first-line therapy and goal-directed and habitual-learning disorder is still unclear. We attempted to discuss the effect of CBT treatment in patients with OCD, using abnormalities in goal-directed and habitual-learning-related brain regions at baseline as predictive factors. A total of 71 subjects, including 35 OCD patients and 36 healthy controls, were recruited. The OCD patients underwent 8 weeks of CBT. These patients were divided into two groups based on treatment response (N responders = 18, N nonresponders = 17). Further subgroup analysis was conducted based on disease duration (N short = 17, N long = 18) and age of onset (N early = 14, N late = 21). We collected resting-state ROI-ROI functional connectivity data and apply repeated-measures linear mixed-effects models to investigate the differences of different subgroups. CBT led to symptom improvement in OCD patients, with varying degrees of effectiveness across subgroups. The orbitofrontal cortex (OFC) and insula, key regions for goal-directed behavior and habitual-learning, respectively, showed significant impacts on CBT efficacy in subgroups with different disease durations and ages of onset. The findings suggest that the goal-directed system may influence the efficacy of CBT through goal selection, maintenance, and emotion regulation. Furthermore, we found that disease duration and age of onset may affect treatment outcomes by modulating functional connectivity between goal-directed and habitual-learning brain regions. • The study examines how CBT affects OCD patients and brain function related to learning patterns. • The research uncovers diverse responses to CBT based on disease duration and age of onset. • The findings emphasize the role of the goal-directed system in influencing CBT's effectiveness. [ABSTRACT FROM AUTHOR]

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Abstract Background Some persons with obsessive–compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet. Methods We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions. Results Obsessive–compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables. Conclusions Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive–compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.

Background: Some persons with obsessive–compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet. Methods: We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions. Results: Obsessive–compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps < 0.001) and global functioning (based on therapist ratings) increased with a large effect size (d = 1.3, p < 0.001) from admission to discharge. In contrast to previous findings, however, WTE did not predict treatment outcome (all ps > 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables. Conclusions: Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive–compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions. [ABSTRACT FROM AUTHOR]

Exposure and response prevention (ERP) is an evidence-based treatment for obsessive-compulsive disorder (OCD). Theories for how it works vary in their emphasis on active mechanisms of change. The current study aimed to clarify mechanisms of change in ERP for OCD using network analysis, comparing ERP networks at the start and end of intensive treatment (partial hospital and residential). In our sample of 182 patients, the most central node in both networks was engagement with exposure, which was consistently related to greater understanding of ERP rationale, higher willingness, and less ritualization, accounting for all other variables in the network. There were no significant differences in networks between the start and end of treatment. These results suggest that nonspecific parameters like facilitating engagement in exposures without ritualizing and providing a clear rationale to clients may be key to effective treatment. As such, it may be useful for clinicians to spend adequate time underscoring the need to eliminate rituals to fully engage in exposure tasks and explaining the rationale for ERP prior to doing exposures, regardless of theoretical orientation. Nonetheless, findings represent group-level statistics and more fine-grained idiographic analyses may reveal individual-level differences with respect to central mechanisms of change. Other limitations include demographic homogeneity of our sample. • Examined mechanisms of change in exposures for OCD using network analysis • Engagement with exposure was consistently the most central node • Engagement was related to understanding rationale, willingness, and ritualizing • Clarifying rationale and practicing willingness may be important for engagement [ABSTRACT FROM AUTHOR]

Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps < 0.01). However, individual patients reported some negative effects of therapy. The results underline the value of thorough investigations of novel therapeutic interventions in naturalistic settings. [ABSTRACT FROM AUTHOR]

While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed. • Exposure and response prevention (ERP) is the first-line treatment for OCD • We examined changes of self-efficacy and distress tolerance over the course of ERP • Patients in an intensive treatment program completed weekly assessment measures • As OCD symptoms improved with ERP, self-efficacy and distress tolerance increased • Self-efficacy and distress tolerance mediated each other in reducing OCD symptoms and both should be important targets in ERP [ABSTRACT FROM AUTHOR]

Objective: Cognitive‐behavioral therapy (CBT), which includes a decided emphasis on exposure and response/ritual prevention (ERP) and between‐session practice of treatment principles, has consistently demonstrated efficacy for the treatment of obsessive‐compulsive disorder (OCD) and is a gold standard, recommended first‐line treatment. CBT with ERP has been successfully adapted to fit the needs of autistic individuals with OCD. The present article provides a brief overview of CBT for OCD and outlines special considerations and adaptations needed when working with patients with OCD and comorbid autism, with an emphasis on the importance of between‐session homework. Method: A case vignette is presented. Results: This case study illustrates the role of homework in the exposure‐based treatment of an adult autistic individual with comorbid OCD. Conclusion: Implications of this case vignette are discussed, and recommendations are offered for clinicians working with autistic individuals with OCD, especially in regard to bolstering completion of between‐session ERP homework. [ABSTRACT FROM AUTHOR]

Differential diagnosis of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) in adolescents is difficult due to similar behavioral topography. For instance, restrictive, repetitive behavior, cognitive rigidity, anxiety, and avoidance contribute to impairment in social relationships and daily living skills in both conditions. The diagnostic picture for youth with ASD and/or OCD may be further clouded by high rates of co-occurring gender-diverse clinical concerns, attention-deficit/hyperactivity disorder, tic disorder, depression, and anxiety disorders With increased prevalence and improved identification of ASD, OCD, and gender-identity-related distress, more adolescents are seeking treatment. It is vital that providers are knowledgeable about best practices for diagnosing and treating these overlapping symptoms. This review describes the state of the literature regarding presentation and prevalence of ASD, OCD, and gender-identity concerns separately and as co-occurring phenomena. Sex differences and gender-diversity among individuals with ASD and OCD are also reviewed. We briefly describe evidence-based behavioral treatments for ASD, OCD, gender-identity-related distress as separate and co-occurring considerations. Recommendations for tailoring within these therapies and family involvement are discussed. [ABSTRACT FROM AUTHOR]

Background: Obsessive-compulsive disorder is a chronic mental disorder that requires different treatments due to its complex nature. Schema therapy (ST) and exposure and response prevention (ERP) are two treatments that have been studied in people with obsessive-compulsive disorder (OCD), and previous studies have shown them to be effective. However, few studies have investigated the effectiveness of integrating these two methods in comparison with other methods. Aims: The study aimed to compare the effectiveness of the ST and the integration of schema therapy with the exposure and response prevention technique (STERP) in treating distress tolerance in women with washing compulsions. Methods: The research method was quasi-experimental with a pre-test-post-test design and a 2-month follow-up. The statistical population included all women with obsessive-compulsive disorder referred to counseling centers in the north and center of Tehran from the beginning of November to the end of February 2020. Forty-five people were selected by a convenience method based on inclusion criteria. The first intervention group (ST) received 12 sessions, and the second intervention group (STERP) received 14 sessions. The research instrument included the Distress Tolerance Scale (DTS) (Simmons & Gaher, 2005). Data were analyzed by mixed-design analysis of variance and Bonferroni test in SPSS-23 software. Results: The results showed that ST and STERP interventions increased distress tolerance in women with washing compulsions at the end of interventions and follow-up period (P

Background: Obsessive-compulsive disorder is a chronic mental disorder that requires different treatments due to its complex nature. Schema therapy (ST) and exposure and response prevention (ERP) are two treatments that have been studied in people with obsessive-compulsive disorder (OCD), and previous studies have shown them to be effective. However, few studies have investigated the effectiveness of integrating these two methods in comparison with other methods. Aims: The study aimed to compare the effectiveness of the ST and the integration of schema therapy with the exposure and response prevention technique (STERP) in treating distress tolerance in women with washing compulsions. Methods: The research method was quasi-experimental with a pre-test-post-test design and a 2- month follow-up. The statistical population included all women with obsessive-compulsive disorder referred to counseling centers in the north and center of Tehran from the beginning of November to the end of February 2020. Forty-five people were selected by a convenience method based on inclusion criteria. The first intervention group (ST) received 12 sessions, and the second intervention group (STERP) received 14 sessions. The research instrument included the Distress Tolerance Scale (DTS) (Simmons & Gaher, 2005). Data were analyzed by mixed-design analysis of variance and Bonferroni test in SPSS-23 software. Results: The results showed that ST and STERP interventions increased distress tolerance in women with washing compulsions at the end of interventions and follow-up period (P<0.0001), but STERP was more effective in treating distress tolerance compared to the ST. Conclusion: The results showed that using exposure and response prevention methods integrated with schema therapy for patients with obsessive-compulsive disorder allows the them to analyze different dimensions of anxiety-inducing stimuli and provides a more appropriate answer to it. [ABSTRACT FROM AUTHOR]

Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Exposure and response prevention (ERP) therapy, a form of cognitive-behavioral therapy, is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD) for adults and children. It is effective for the majority of those who engage in it, but treatment adherence can be challenging for some due to the stress involved in the treatment as well as different life circumstances that arise. To help improve treatment adherence, NOCD, a provider of video teletherapy ERP, identifies those at risk of non-adherence using a prediction algorithm trained on a data set of N = 13,809 and provides targeted peer support interventions by individuals ("Member Advocates") who successfully completed ERP treatment for OCD. Member Advocates, using lived OCD experience as well as experience with ERP, engage at-risk patients through digital messaging to engage, educate, and encourage patients in the early stages of treatment. From June 2022 to August 2022, N = 815 patients deemed at risk were reached out to and n = 251 responded and engaged with the Member Advocates. In the at-risk patients who engaged, the intervention resulted in a significant mean 30.4% more therapy hours completed compared to those who did not engage. Additionally, engaged patients had greater reductions in OCD severity. These results have implications for how data science, digital interventions, and strategic peer-to-peer communication and support can be combined to enhance the effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD. [ABSTRACT FROM AUTHOR]

Individuals with obsessive compulsive disorder (OCD) may have psychological comorbidity and behaviors that interfere with effective treatment. Exposure and response prevention (ERP) is the most efficacious treatment for OCD to date. Several studies exist examining the impact of comorbid major depressive disorder (MDD), generalized anxiety disorder, and other anxiety disorders on response to ERP, whereas almost none examine the impact of eating disorders or nonsuicidal self-injury on the effectiveness of ERP. This makes it difficult to determine readiness, specifically in regard to ERP treatment, when clients present with OCD and comorbid conditions other than MDD and anxiety-related conditions. This article describes a decision-making model for clinicians regarding whether or not to begin ERP when a client has comorbid symptoms that are potentially life threatening and impact their functioning more severely than the OCD diagnosis. The decision-making model was developed based on previous models of readiness for ERP (VanDyke & Pollard, 2005) and incorporates research literature and the treatment team's clinical experience with other severe psychopathology. The model is described and two case examples are presented: one who was ready for ERP treatment and the other who was not and was therefore referred for another evidence-based intervention. Public Significance Statement: Exposure and response prevention is an effective treatment for obsessive compulsive disorder (OCD). Many individuals with OCD have co-occurring conditions such as eating disorders, suicidality, and major depressive disorder. This study described a model to assist clinicians in making decisions about how to sequence treatment for OCD when an individual has other co-occurring conditions that also severely impact quality of life. [ABSTRACT FROM AUTHOR]

Background: Little is known about the long‐term effectiveness of behavioural therapy for tics. We aimed to assess the long‐term clinical and cost‐effectiveness of online therapist‐supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. Methods: ORBIT (online remote behavioural intervention for tics) was a two‐arm (1:1 ratio), superiority, single‐blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self‐referral. This study was a naturalistic follow‐up of participants at 12‐ and 18‐month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS‐TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207); ClinicalTrials.gov (NCT03483493). Results: Two hundred and twenty‐four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS‐TTSS by 2.64 points (95% CI: −4.48 to −0.79) with an effect size of −0.36 (95% CI: −0.61 to −0.11) after 12 months and by 2.01 points (95% CI: −3.86 to −0.15) with an effect size of −0.27 (95% CI ‐0.52 to −0.02) after 18 months, compared with psychoeducation. Very few participants (<10%) started new tic treatment during follow‐up. The cost difference in ERP compared with psychoeducation was £304.94 (−139.41 to 749.29). At 18 months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation. Conclusions: Remotely delivered online ERP is a clinical and cost‐effective intervention with durable benefits extending for up to 18 months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics. [ABSTRACT FROM AUTHOR]

Abstract Background Obsessive-Compulsive Disorder (OCD) is characterized by disturbing and unwanted thoughts as well as repetitive and time-consuming behaviors that interfere with performance. Cognitive Behavior Therapy (CBT) has shown to have beneficial effects on reducing OCD symptoms as the first line of treatment. Moreover, Virtual Reality (VR) has been a more feasible and accessible intervention for OCD in recent years. Regarding the point, the objective of this study was to evaluate the effectiveness of virtual reality exposure and response prevention (VRERP) in the treatment of the OCD contamination subtype. Methods A total number of 36 adults with OCD-contamination subtype were registered and randomly assigned to the intervention and control groups. The intervention group received a 60-min CBT including a “contaminated” virtual environment while the control group received CBT as a standardized treatment. Out of these, 29 patients completed the treatment in 12 weekly sessions. The patients completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Obsessive Beliefs Questionnaire-44(OBQ-44), and World Health Organization Disability Assessment Scale-2 (WHODAS-2) at week 0, week 12 and after 3 months follow-up. Results Based on the results of the repeated measure analysis of variances, the total score of obsession and compulsion subscales of Y-BOCS significantly decreased as a primary outcome in the intervention group (F = 60.97, P

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized. [ABSTRACT FROM AUTHOR]

• ACT combined with ERP delivered in an intensive outpatient setting was found to be effective. • Results showed a significant decrease in OCD symptom severity in adults. • Psychological inflexibility, depression, anxiety, and stress significantly improved during treatment. Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment. [ABSTRACT FROM AUTHOR]

Tourette syndrome and chronic tic disorders are characterized by the presence of tics. Different behavioral therapies have shown to be efficacious for treating tics in children and adolescents, but Exposure and Response Prevention (ERP) is a less researched method. However, ERP is a method often used in the clinical setting. Therefore, the present study evaluated the severity of tics over time from beginning of ERP to follow-up approximately 1 year after last training session. In total, 116 patients treated with ERP face to face or ERP via web-based videoconferencing were included. The primary outcome measure was tic severity measured with the Danish version of the Yale Global Tic Severity Scale. The results showed that tic severity decreased during ERP and lasted in the follow-up period, with a statistically higher decrease in the group with patients who completed ERP as planned and the group that stopped earlier than planned because of reduction in tics, compared with those who dropped out due to lack of motivation (p < 0.001). The study concludes that ERP seems to have an immediate and a long-term effect on severity of tics, especially in those who complete the program or those who discontinue earlier due to good results. [ABSTRACT FROM AUTHOR]

Chronic tic disorders, such as Tourette syndrome, are characterized by motor and vocal tics. Tics present a considerable burden for some patients, and therefore, effective treatment is important. One evidence-based treatment option is a behavioral therapy called exposure and response prevention (ERP). Despite its effectiveness, access to ERP remains limited due to a lack of treatment sites. Web-based videoconferences can connect patients at home with a therapist located in the hospital, allowing for treatment delivery over a wide geographic area. The primary aim of this study was to compare the development of tics during and 1 year after ERP delivery, respectively, via web-based videoconferences and traditional face-to-face methods in a naturalistic setting. In total, 116 patients treated using either the face-to-face method (n = 72) or web-based videoconferences (n = 44) were included. The primary outcome measure was tic severity. In both training modalities, tic severity decreased during ERP and the effect lasted in the follow-up period. No statistically significant differences in tic severity between the training modalities were found at baseline, last training session, or at follow-up. Our results suggest that ERP delivered via web-based videoconferences is a good alternative to the traditional face-to-face method. [ABSTRACT FROM AUTHOR]

Repugnant obsessions are a common theme of intrusions in obsessive-compulsive disorder and are typically ego-dystonic. Exposure and response prevention (ERP) is the first-line intervention and involves in vivo and/or imaginal exposures. Many therapists are however reluctant to conduct ERP and the reasons remain unclear. Similarly, little is known about therapist preference for in vivo versus imaginal exposure for repugnant obsessions. To address these gaps, 200 therapists read vignettes of an in vivo and imaginal exposure for each repugnant obsession subtype and indicated whether they would have clients complete it. If not, they selected their primary refusal reason. Therapists were more likely to refuse in vivo (versus imaginal) exposures related to intentional/accidental harm, religion, and sexual orientation. There were no differences in willingness for pedophilic obsessions, with both forms receiving more refusals than approvals. "Dangerous/harmful to client/others" and "not necessary for therapeutic success" were most frequently selected as refusal reasons. [ABSTRACT FROM AUTHOR]

Exposure and response prevention (ERP) is the gold standard in the treatment of the obsessive–compulsive disorder (OCD). It can be delivered effectively using an individual or group therapy format. Nonetheless, a sizeable proportion of people diagnosed with OCD do not experience OCD symptom remission following ERP. Research suggests that participant engagement with ERP tasks predicts therapy outcomes but there is little consistent evidence across studies on what predicts engagement. A recent meta‐analysis of participant engagement in cognitive‐behavioral therapy for OCD found that group ERP had a comparatively lower dropout rate than individual ERP. Little is known about participant perceptions of ERP to guide an understanding of how the group therapy format may affect participant engagement. This study conducted a qualitative exploration of what helps or hinders participants' engagement in group ERP. It involved thematic analysis of semi‐structured interview data collected at a 6‐month follow‐up from 15 adults with OCD who took part in group ERP. The study identified five main themes that captured participants' perceived facilitators and barriers to engagement in therapy: 'Group processes', 'Understanding how to overcome OCD', 'Personal relevance', 'Personal circumstances', and 'Attitudes towards ERP', which captured dynamically inter‐related barriers and facilitators at the level of the client, therapist, therapy and social environment. Each theme and associated sub‐themes are discussed in turn, followed by a consideration of the study's limitations and implications. [ABSTRACT FROM AUTHOR]

Abstract Introduction Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. Methods A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Results Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. Conclusion TBCT may be a valid and promising treatment for this disorder.

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Introduction: Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. Methods: A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Results: Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. Conclusion: TBCT may be a valid and promising treatment for this disorder. [ABSTRACT FROM AUTHOR]

Background: Various studies have investigated the effectiveness of Exposure and Response Prevention (ERP) on obsessive-compulsive disorder and depression, but few studies have examined ERP in a competitive trial with other methods such as mindfulness-based cognitive-behavioral therapy (MBCBT). Aims: The purpose of this study was to compare the effectiveness of two methods of mindfulness-based cognitive-behavioral therapy (MBCBT) and Exposure and Response Prevention (ERP) on obsessive-compulsive disorder and comorbid depression in women with obsessive-compulsive disorder. Methods: This study was designed as an “applied and quasi-experimental research” with pretest-posttest and follow-up design with two experimental groups 1 and 2 and control group. The statistical population in this study included all women in the age group of 20 to 45 years who referred to Amina and Rayen Psychological Services and Counseling Center in Tehran in 2018, 36 of whom were selected through purposeful sampling and were divided into three groups: 1) MBCBT group (n = 12), ERP group (n = 12) and control group (n = 12). Research tools included the Yale Brown Obsessive-Compulsive Disorder Questionnaire (Goodman, 1986) and the Beck Depression Inventory 2 (Beck, 1979). Data analysis was performed using repeated measures analysis of variance test by SPSS-21 software Results: In the post-test phase, both interventions had a significant effect on obsessive-compulsive disorder and depression (p >0.05). In the follow-up phase, two interventions significantly reduced obsessive-compulsive disorder and depression, but MBCBT was more effective. Conclusion: Based on the findings of this study, it can be concluded that MBCBT and ERP can be used to reduce the rate of obsessive-compulsive disorder and depression in women with obsessive-compulsive disorder.

Abstract Background Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome. Method In a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions. Results In a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings. Conclusions The results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.

Background: Obsessive-Compulsive Disorder (OCD) is characterized by disturbing and unwanted thoughts as well as repetitive and time-consuming behaviors that interfere with performance. Cognitive Behavior Therapy (CBT) has shown to have beneficial effects on reducing OCD symptoms as the first line of treatment. Moreover, Virtual Reality (VR) has been a more feasible and accessible intervention for OCD in recent years. Regarding the point, the objective of this study was to evaluate the effectiveness of virtual reality exposure and response prevention (VRERP) in the treatment of the OCD contamination subtype. Methods: A total number of 36 adults with OCD-contamination subtype were registered and randomly assigned to the intervention and control groups. The intervention group received a 60-min CBT including a "contaminated" virtual environment while the control group received CBT as a standardized treatment. Out of these, 29 patients completed the treatment in 12 weekly sessions. The patients completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Obsessive Beliefs Questionnaire-44(OBQ-44), and World Health Organization Disability Assessment Scale-2 (WHODAS-2) at week 0, week 12 and after 3 months follow-up. Results: Based on the results of the repeated measure analysis of variances, the total score of obsession and compulsion subscales of Y-BOCS significantly decreased as a primary outcome in the intervention group (F = 60.97, P < 0.001, partial eta squared = 0.82; F = 20.46, P < 0.001, partial eta squared = 0.61; F = 29.57, P < 0.001, partial eta squared = 0.69; respectively). The total score of BDI-II and BAI was reduced in both groups but there was no significant difference between them (BDI-II: F = 0.54, P = 0.47, partial eta squared = 0.02; BAI: F = 3.12, P = 0.06, partial eta squared = 0.19). However, there was a significant difference in the OBQ-44 (F = 16.78, P < 0.001, partial eta squared = 0.56) and the total WHODAS-2 score between the groups (F = 14.64, P < 0.001, partial eta squared = 0.53). Conclusions: This study demonstrated the effectiveness of VRERP in the treatment of the OCD-contamination subtype. Therefore, VRERP can be used in CBT as an alternative exposure tool. Trial registration: Iranian Registry of Clinical Trials, IRCT ID: IRCT20210214050353N1, Registered on 16/10/2021. [ABSTRACT FROM AUTHOR]

Exposure and response prevention (ERP) is an evidence-supported intervention indicated by international guidelines for the treatment of obsessive-compulsive disorder and anxiety disorders. Nevertheless, some studies show that it is still underutilized in clinical practice. The consulted literature inspired this pilot study, which aims to investigate the use of ERP among Italian cognitive psychotherapists. A specific questionnaire, adapted from the survey conducted by Sars et al. (2015) focused on ERP use, with the addition of specific items assessing the therapist's personal variables, specifically anxiety and guilt sensitivity and self-efficacy, was administered to participants. Results showed that beliefs about the effectiveness of exposure techniques and positive attitudes about their use led respondents to use ERP more frequently, especially if they had few years of experience in clinical practice. In addition to specific beliefs on ERP, some personal characteristics of the therapist, such as perceived self-efficacy and guilt sensitivity, also appear to play a role in ERP use. The data are discussed in the light of current literature. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral therapies are recommended as a first-line intervention for Tourette syndrome and persistent motor or phonic tic disorder., Areas Covered: In this review, the authors summarize randomized controlled trials on the comprehensive behavioral intervention for tics (CBIT), habit reversal therapy (HRT), and exposure and response prevention (ERP). Studies of face-to-face treatment, treatment by video conferencing, group treatment, and internet delivered treatment were assessed, as well as evidence of treatment predictors, modifiers, and mediators., Expert Opinion: There is high-quality evidence for face-to-face one-on-one treatment with CBIT, and data suggesting that one-on-one treatment by videoconference provides similar benefit. Limited data on group treatment with CBIT/HRT suggests inferiority to individual treatment, while internet-based CBIT programs appear more beneficial than wait list or psychoeducation. There is one face-to-face one-on-one treatment comparison of ERP to HRT, suggesting equal benefit. Internet-based ERP with minimal therapist support appears effective, although effect sizes are small. One study using behavioral therapy with ERP or HRT found similar benefit to medical treatment with antipsychotics. Data on predictors, modifiers, and mediators of treatment efficacy are emerging. In summary, behavioral therapies are an important treatment modality for tic disorders. Furthermore, important efforts to improve treatment accessibility are underway.

Background: Exposure and response prevention (ERP) is a form of cognitive behavioral therapy that can effectively relieve obsessivecompulsive symptoms and tic symptoms in patients with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). However, the effect size of ERP-based therapy is still unclear. Methods: In this study, we performed a meta-analysis to identify the efficacy of ERP-based therapy for individuals with OCD and TS. The standard mean difference (SMD) with a 95% confidence interval (CI) was calculated to assess the effect size of the efficacy for ERP-based therapy. We used subgroup and meta-regression analyses to explore the heterogeneity of the pooled SMD of ERP-based therapy for OCD. We also summarized the neuroimaging studies for ERP-based therapy for OCD. This meta-analysis was registered within the International Platform of Registered Systematic Review and Meta-analysis Protocols (number: INPLASY2021120112). Results: A total of 18 studies including a total of 1057 patients with OCD and 3 studies including 267 with TS/chronic tic disorder were identified. We did not observe any indication of publication bias using Egger’s funnel plot (p = 0.41). We observed a small-to-medium effect size of ERP for both OCD (SMD = –0.27, 95% CI: –0.53 to –0.01) and TS/chronic tic disorder (SMD = –0.35, 95% CI: –0.59 to –0.1). We found no heterogeneity of ERP-based therapy for OCD between the ERP-based therapy subgroup and medicine subgroup in the subgroup analysis (p = 0.72). We found no heterogeneity of ERP-based therapy for OCD between the child subgroup and adult subgroup in the subgroup analysis (p = 0.37). We used meta-regression analysis to identify the heterogeneity of ERP-based therapy for OCD and found that the sessions of therapy and publication year did not account for any significant heterogeneity (p > 0.05). The neurological mechanism of EPR-based therapy is unclear, but it may lie in changes in the prefrontal cortex and anterior cingulate cortex. Conclusions: In conclusion, we found that ERP-based therapy is effective for patients with OCD and TS/chronic tic disorder. We suggest a combination with other therapies and the development of online ERP services that might prove a promising new direction for healthcare providers. [ABSTRACT FROM AUTHOR]

Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders—especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example. [ABSTRACT FROM AUTHOR]

This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomized controlled trial in Iran of 12 individual weekly sessions of either ACT+SSRI, ERP+SSRI, or continued SSRI only. The results showed significant reductions in OCD symptom severity in ACT+SSRI and ERP+SSRI conditions at posttreatment with significantly greater reductions in both conditions compared to SSRI-only at follow-up. Additionally, psychological inflexibility and use of thought control strategies significantly decreased in the ACT+SSRI condition at posttreatment and follow-up compared to the ERP+SSRI and SSRI conditions. Both conditions led to decreases in perceived importance of stop signals. Results provide cross-cultural support for the treatment of OCD using ACT and ERP as adjuncts to SSRI and modest process of change differences between ACT and ERP. Future directions and study limitations are discussed. [ABSTRACT FROM AUTHOR]

Exposure and response prevention (ERP) is the most empirically supported treatment for obsessive-compulsive disorder (OCD). However, details on how to effectively conduct ERP are lacking. The current study aimed to identify exposure parameters associated with better subsequent outcomes in ERP for OCD. We analyzed data from 271 therapy sessions across 46 participants in a randomized controlled trial comparing traditional ERP and ERP conducted from an acceptance and commitment therapy framework (ACT + ERP). Multilevel model results indicated that experiential delivery of acceptance/tolerance practice was associated with higher exposure homework adherence, lower psychological inflexibility, and less OCD symptom severity (except contamination) the following week, underscoring the potential importance of experiential learning in ERP. In addition, exposure parameters had differential effects across symptom dimensions: more collaboration when designing exposures predicted less concern about unacceptable thoughts, whereas explaining the rationale of ERP was associated with less symmetry concerns a week later. While more research is needed to further clarify the workings of ERP, our findings tentatively support use of experiential learning over didactic teaching of acceptance/tolerance and personalization of exposure parameters based on presenting OCD dimension. • Coded exposure parameters from 271 ERP and ACT + ERP therapy sessions. • Experiential delivery of acceptance/tolerance skills predicted better outcomes. • Exposure parameters had differential effects across symptom dimensions. [ABSTRACT FROM AUTHOR]