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

Helen B Simpson; Edna B Foa; Michael G Wheaton; Thea Gallagher; Marina Gershkovich; Andrew B Schmidt; Jonathan D Huppert; Raphael B Campeas; Patricia A Imms; Shawn P Cahill; Christina DiChiara; Steven D Tsao; Anthony C Puliafico; Daniel Chazin; Anu Asnaani; Kelly Moore; Jeremy Tyler; Shari A Steinman; Arturo Sanchez-LaCay; Sandy Capaldi; Ivar Snorrason; Elizabeth Turk-Karan; Donna Vermes; Eyal Kalanthroff; Anthony Pinto; Chang-Gyu Hahn; Bin Xu; Page E Van Meter; Martha Katechis; Jennifer Scodes; Yuanjia Wang

doi:10.1016/j.brat.2021.103890

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

Behav Res Ther. 2021 Aug:143:103890. doi: 10.1016/j.brat.2021.103890. Epub 2021 May 29.

Authors

Helen B Simpson¹, Edna B Foa², Michael G Wheaton³, Thea Gallagher², Marina Gershkovich⁴, Andrew B Schmidt⁴, Jonathan D Huppert⁵, Raphael B Campeas⁴, Patricia A Imms², Shawn P Cahill⁶, Christina DiChiara⁷, Steven D Tsao⁷, Anthony C Puliafico⁴, Daniel Chazin², Anu Asnaani⁸, Kelly Moore⁹, Jeremy Tyler², Shari A Steinman¹⁰, Arturo Sanchez-LaCay⁴, Sandy Capaldi², Ivar Snorrason¹¹, Elizabeth Turk-Karan², Donna Vermes⁴, Eyal Kalanthroff⁵, Anthony Pinto¹², Chang-Gyu Hahn², Bin Xu¹³, Page E Van Meter⁴, Martha Katechis⁴, Jennifer Scodes¹⁴, Yuanjia Wang¹⁵

Affiliations

¹ Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA. Electronic address: Blair.Simpson@nyspi.columbia.edu.
² Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA.
³ New York State Psychiatric Institute, New York, NY, 10032, USA; Barnard College, Columbia University, New York, NY, 10027, USA.
⁴ Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.
⁵ The Hebrew University of Jerusalem, Israel.
⁶ University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA.
⁷ Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA.
⁸ Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA.
⁹ Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA.
¹⁰ Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychology, WVU, Morgantown, WV, 26506, USA.
¹¹ Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA.
¹² Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA.
¹³ Department of Psychiatry, Columbia University, New York, NY, 10032, USA.
¹⁴ New York State Psychiatric Institute, New York, NY, 10032, USA.
¹⁵ Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.

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.

Keywords: CBT; Cognitive-behavioral therapy; EX/RP; Exposure and ritual prevention; OCD; Obsessive-compulsive disorder.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Cognitive Behavioral Therapy*
Combined Modality Therapy
Humans
Obsessive-Compulsive Disorder* / therapy
Patient Compliance
Selective Serotonin Reuptake Inhibitors / therapeutic use
Treatment Outcome

Substances

Serotonin Uptake Inhibitors

Abstract

Publication types

MeSH terms

Substances

Grants and funding