Study Suggests Clients Don’t Dropout of ERP for OCD More than for Any Other Treatment

A common figure for the dropout rate of exposure and response prevention (ERP) for people with obsessive-compulsive disorder is about 25%.  During one OCD workshop I attended, 2 different presenters insinuated that these high rates of dropout were the result of one particularly overzealous researcher who pushed clients too hard! They suggested that, anecdotally, most people with OCD can tolerate exposure-work reasonably well.

A recent study from Utah State professor Michael Twohig’s lab decided to take a closer look at this.

Meta-Analysis

The researchers collected 21 studies of ERP for OCD and conducted a meta-analysis of dropout rates. In a meta-analysis, researchers try to compute variables in order to compare results across multiple studies with different methodologies.

The researchers looked at refusal of treatment and dropout. They also defined what they called “attrition” as a combination of: a.) people who refuse the treatment (i.e., ERP) altogether; b.) people who begin ERP treatment and dropout prematurely. They noted that few researchers track refusal rates, so this remains an understudied variable.

What they found

The researchers found that overall attrition (refusal + dropout) was 18.7%, 12.0% refused treatment, and 14.7% began treatment before dropping out. They did not find any strong predictors of dropout.

In comparing their results to other published research, the authors observed that the dropout rate of 18.7% is similar to those found for PTSD (18.3%) and major depressive disorder (17.5%) and for cognitive behavioral therapy across disorders (26.2%).

Summary

As many therapists are reluctant to use exposure, this study is important in providing evidence that people with OCD may be as open to ERP as they are to any other evidence-based treatment. This is important because ERP has the greatest research support and many people with OCD struggle to find therapists who offer effective treatment.

If you’d like to read the study yourself, you can download a pdf here.

Brian Thompson Ph.D.

Author: Brian Thompson Ph.D.

Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.

An Alternative to Exposure and Response Prevention for OCD

An Alternative to Exposure and Response Prevention for OCD

Numerous studies have now shown that Exposure and Response (or Ritual) Prevention (ERP) remains  our most effective treatment for obsessive-compulsive disorder (OCD).  In ERP, clients deliberately confront feared stimuli while learning to refrain from engaging in compulsions.

Even with the effectiveness of ERP, the search continues for how to get even better results, as not everyone benefits from ERP and some clients are resistant to it. Recent research on Acceptance and Commitment Therapy (ACT) suggests that other approaches—such as learning to observe obsessions without engaging or “buying into” the content of the obsessions—can supplement ERP. One of the core ideas of ACT is helping clients to mindfully observe obsessions with greater distance.

I recently came across a new paper that focuses on these newer approaches to OCD and thought it might be helpful for clinicians working with OCD. The authors provide a nice summary of recent research on the use of ACT, Dialectical Behavior Therapy, mindfulness-based approaches, and Metacognitive Therapy in the treatment of OCD.  They also provide some background on the roots of ERP in behaviorism and (later) cognitive therapy. The authors summarize what makes these approaches unique in the treatment of OCD:

In general we agree that most approaches to OCD address the function of inner experiences to some degree; in addition arguing that what makes the approaches covered here unique is the greater or complete shift toward addressing the function of inner experiences and a substantial reduction in categorizations of types or styles of inner experiences. (p. 34)

I would like to emphasize that none of these newer strategies are incompatible with ERP. I often find they are a useful complement to exposure work in my clinical work. My sense is that these strategies can help us expand our range of effective treatment interventions for OCD to help prepare clients for exposure work or as an alternative for those who are not willing to engage in ERP.

If you’d like to read the paper, you can currently download a pdf for free here. For a list of other blog posts I’ve written about exposure, click on this link.

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