Frequency and level of self-efficacy predict the effectiveness of therapist- and self-guided exposure in obsessive compulsive disorder

Voderholzer, Ulrich; Hilbert, Sven; Fischer, Anne; Neumüller, Jakob; Schwartz, Caroline; Heßler, Johannes Baltasar

doi:10.1017/s1352465820000582

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…Also, self-efficacy, someone's belief in his or her capacity to perform actions necessary to attain certain goals, has found to be positively correlated with symptom severity in OCD [20,21]. Moreover, self-efficacy was found to have a mediating role in the treatment of OCS [22]. Since our experimental condition appeals to patients their own contribution in their treatment approach we aim to investigate if there is a difference in the increase of selfefficacy between conditions and if self-efficacy works as a mediating factor on treatment effect.…”

Section: Background and Rationale {6a}mentioning

confidence: 94%

Personalized exposure and ESM feedback versus exposure as usual for OCD: a study protocol for a randomized controlled trial

Hoogerwerf

Greeven

Goekoop

et al. 2023

Preprint

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Background This study aims to compare personalized exposure with response prevention (ERP) using experience sampling methodology-based feedback to ERP as usual in patients with obsessive-compulsive disorder (OCD). Personalized exposure will be provided screen-to-screen in an ecologically valid (real time and real place) context by means of a smartphone application. This app will also be used to collect both objective and subjective data by means of experience sampling methodology (ESM). This ESM-data will be used to identify triggers and protective factors for symptom severity, provide personalized feedback and optimize the effect of ERP. The primary goal of this RCT is to compare the effectiveness of personalized ERP to ERP as usual in the traditional context of a therapist’s room in patients with OCD in OCD symptom severity. Since both self-efficacy and experiential avoidance are known to influence symptom-severity in OCS, a secondary goal is to examine if a possible treatment effect is mediated by self-efficacy or experiential avoidance. Methods This study involves a randomized controlled trial with 20 weekly sessions by 2 groups (ERP as usual versus personalized ERP), repeated measurements at baseline (T0), 5 weeks of treatment (T1), 10 weeks of treatment (T2), 15 weeks of treatment (T3), posttest at 20 weeks (T4), 6 weeks follow-up (T5), 3 months follow-up (T6), 6 months follow-up (T7) and a year follow-up (T8). A hundred and sixty patients with an OCD diagnosis according to DSM-5 criteria will participate. Half of the group will receive exposure with response prevention as usual, the other half will receive personalized exposure with response prevention with a smartphone application and personalized feedback sessions based on experience sampling data. Discussion This randomized controlled trial is the first to assess the influence of delivering ERP through video calling and the use of an ESM intervention on the symptom severity of OCD. Since the global pandemic COVID-19, the use of video calling to deliver psychological treatments has become more common, increasing the relevance of this study. Trial registration: ICTRP Trial NL8254 registered on 2019-12-24 url: https://trialsearch.who.int/Trial2.aspx?TrialID=NL8254

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Section: Background and Rationale {6a}mentioning

confidence: 94%

Personalized exposure and ESM feedback versus exposure as usual for OCD: a study protocol for a randomized controlled trial

Hoogerwerf

Greeven

Goekoop

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Moreover, van Hout and Emmelkamp [ 36 ] found a relation between overestimation of the level of distress during exposure and subsequently increased self-efficacy. There is also first evidence that self-efficacy mediates outcome of self-guided ERP [ 17 , 66 ]. In order to account for self-efficacy change (SEC) as a control variable in the present study, we calculated a difference score between the confidence in conducting exposure as planned prior to ERP (3) and the post-ERP confidence in conducting the same ERP task again (6) for the first two standardized ERP sessions (SEC ERP1 , SEC ERP2 ).…”

Section: Methodsmentioning

confidence: 99%

“…First approaches to predict treatment response by fear extinction learning in OCD [ 14 ] are promising but still rare. Moreover, it has been shown that frequency of and adherence to ERP [ 15 – 17 ] is associated with outcome, suggesting that the intervention technique itself rather than non-specific variables are crucial for symptom reduction. Nevertheless, different strategies to augment the effects of ERP, e.g.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy

et al. 2022

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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.

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“…Treatment sessions are typically an hour in length and can be administered weekly or multiple times weekly in a standard outpatient setting or daily for several hours a day in intensive outpatient, partial hospitalization, or residential treatment settings 9 . Similarly, exposure and response prevention can be administered in the context of individual or group treatment and is available via the internet and as a self-administration module 7,28,34,37,38 . In all forms, patients who are undergoing exposure and response prevention for OCD are typically asked to complete exposure and response prevention homework between treatment sessions; usually, the homework is to be completed daily, either for a prescribed period of time (eg, waiting for 15 minutes to wash one’s hands) or for a prescribed number of repetitions (eg, driving by a particularly feared intersection 2 times a day without going back to check whether an accident had happened there).…”

Section: Treatment Of Obsessive-compulsive Disordermentioning

confidence: 99%

“…9 Similarly, exposure and response prevention can be administered in the context of individual or group treatment and is available via the internet and as a self-administration module. 7,28,34,37,38 In all forms, patients who are undergoing exposure and response prevention for OCD are typically asked to complete exposure and response prevention homework between treatment sessions; usually, the homework is to be completed daily, either for a prescribed period of time (eg, waiting for 15 minutes to wash one's hands) or for a prescribed number of repetitions (eg, driving by a particularly feared intersection 2 times a day without going back to check whether an accident had happened there). The assignment and completion of exposure and response prevention homework is an integral part of effective treatment for OCD.…”

Section: Key Pointsmentioning

confidence: 99%

Obsessive-Compulsive Disorders

Mathews¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed. RECENT FINDINGS OCD affects 2% to 3% of adults worldwide and is associated with substantial individual disability and societal costs. Lack of recognition of common OCD symptom types, in addition to shame and fear of stigma on the part of patients, has created an average delay in diagnosis by almost 10 years and a delay in effective treatment (ie, a treatment gap) of nearly 2 years. Cognitive-behavioral therapy (CBT), specifically a form of CBT that includes a type of behavioral intervention called exposure and response prevention, remains the most effective form of treatment for OCD. If CBT is not effective or not available, pharmacologic treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a nonselective serotonin reuptake inhibitor, can also be of benefit. Neuromodulation approaches such as deep brain stimulation and transcranial magnetic stimulation are rapidly emerging as effective treatments for OCD, particularly for patients who have not experienced an adequate response to psychotherapy or pharmacologic management. SUMMARY OCD affects more than one in every 50 adults in the United States but is recognized and adequately treated in fewer than half of those affected. Early intervention and appropriate treatment can substantially reduce OCD symptom severity, improve quality of life, and minimize the functional disability associated with this chronic and often debilitating illness.

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Frequency and level of self-efficacy predict the effectiveness of therapist- and self-guided exposure in obsessive compulsive disorder

Cited by 14 publications

References 6 publications

Personalized exposure and ESM feedback versus exposure as usual for OCD: a study protocol for a randomized controlled trial

Personalized exposure and ESM feedback versus exposure as usual for OCD: a study protocol for a randomized controlled trial

Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy

Obsessive-Compulsive Disorders

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