TY - JOUR
T1 - Predictors of treatment outcome in OCD: An interpersonal perspective
AU - Tibi, Lee
AU - van Oppen, Patricia
AU - van Balkom, Anton J. L. M.
AU - Eikelenboom, Merijn
AU - Emmelkamp, Paul M. G.
AU - Anholt, Gideon E.
PY - 2019
Y1 - 2019
N2 - Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
AB - Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
KW - Attachment style
KW - Exposure and response prevention
KW - Longitudinal
KW - Obsessive compulsive disorder
KW - Predictors
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85074362197&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31704634
U2 - https://doi.org/10.1016/j.janxdis.2019.102153
DO - https://doi.org/10.1016/j.janxdis.2019.102153
M3 - Article
C2 - 31704634
SN - 0887-6185
VL - 68
JO - Journal of anxiety disorders
JF - Journal of anxiety disorders
M1 - 102153
ER -