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Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder.

Authors :
Simpson HB
Foa EB
Wheaton MG
Gallagher T
Gershkovich M
Schmidt AB
Huppert JD
Campeas RB
Imms PA
Cahill SP
DiChiara C
Tsao SD
Puliafico AC
Chazin D
Asnaani A
Moore K
Tyler J
Steinman SA
Sanchez-LaCay A
Capaldi S
Snorrason I
Turk-Karan E
Vermes D
Kalanthroff E
Pinto A
Hahn CG
Xu B
Van Meter PE
Katechis M
Scodes J
Wang Y
Source :
Behaviour research and therapy [Behav Res Ther] 2021 Aug; Vol. 143, pp. 103890. Date of Electronic Publication: 2021 May 29.
Publication Year :
2021

Abstract

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.<br /> (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1873-622X
Volume :
143
Database :
MEDLINE
Journal :
Behaviour research and therapy
Publication Type :
Academic Journal
Accession number :
34089924
Full Text :
https://doi.org/10.1016/j.brat.2021.103890