Determining prognostic variables of treatment outcome in obsessive–compulsive disorder: effectiveness and its predictors in routine clinical care

Abstract

The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive–compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive–behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD–symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.

Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?

“…Recent studies of intensive programs published after that meta-analysis have reported largely similar mean reductions in the Y-BOCS [ 106 , 108 - 110 ]. Response rates have ranged from 43 to 79% and remission from 26 to 58% [ 113 , 114 ]. Exit interviews with participants reveal four major themes related to intensive programs: (a) validation in speaking with others with experience of OCD; (b) less impact from their symptoms and re-engaging in activities; (c) intensity and necessity of ERP for recovery and the support of the team; and (d) personal and program-related challenges and satisfaction [ 115 ].…”

Predictors of the 6-year outcome of obsessive-compulsive disorder: Findings from the Netherlands Obsessive-Compulsive Disorder Association study

“…First, many of the of the studies had used only one follow-up examination (Bloch et al, 2014;Cabedo et al, 2010;Eisen et al, 2010), which limits the ability to infer the effect of a certain predictor on the course of OCD (Bloch, 2017). In addition, most studies have focused largely on demographic and clinical prognostic variables, while neglecting other, potentially meaningful social or psychological determinants (Herzog et al, 2021;Van Oudheusden et al, 2018). Furthermore, most of the prediction studies were conducted within the context of controlled clinical trials; therefore, including OCD patients who received pharmacotherapy and/or CBT, and naturalistic studies were less common (Bloch, 2017;Cherian et al, 2014).…”

“…Controlled clinical trials have demonstrated that the majority of patients receiving cognitive-behavioral therapy (CBT) based on exposure and response prevention (ERP) and/or pharmacotherapy experience significant improvement in their symptoms (Bloch et al, 2014; Sookman et al, 2021). Unfortunately, among patients who come to clinical attention, only about 40% receive OCD-tailored treatment and only 10% receive evidence-based treatment (Herzog et al, 2021; Hirschtritt et al, 2017; Torres et al, 2007). Furthermore, prospective studies that examined the long-term outcome of OCD patients receiving evidence-based treatment demonstrated varied long-term remission rates, ranging from 17% to 65% (Bloch et al, 2014; Cherian et al, 2014; Eisen et al, 2013; Marcks et al, 2011; Micali et al, 2010; Sharma et al, 2014; Van Oppen et al, 2005).…”

“…In our previous report on the 4-year naturalistic outcome of OCD, we found that early age of onset and a history of childhood trauma predicted a poor illness course, and that secure attachment style was associated with a more favorable course (Tibi et al, 2020). However, the results in this field of research are inconsistent to some extent (Eisen et al, 2010; Herzog et al, 2021; Marcks et al, 2011), which may be attributed to methodological variations across studies, related to the sample characteristics, follow-up durations, outcome assessments and even the method of the statistical analysis (Kempe et al, 2007; Sharma and Math, 2019).…”

Treatment Course Comparison Between Anxiety-Related Disorders in Adult Outpatients

“…After all, most anxiety-related studies on the course of treatment involve a single anxiety disorder ( e.g. , Herzog et al, 2022; Hunt et al, 2022; Probst et al, 2022), and the occasional studies that do compare treatment course of different anxiety-related disorders mainly concern a combined sample (depressive and anxiety disorders, e.g. , Rayner et al, 2022; participants with and without treatment, e.g.…”