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

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 CapaldiIvar 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

School of Medicine

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Article number	103890
Journal	Behaviour Research and Therapy
Volume	143
DOIs	https://doi.org/10.1016/j.brat.2021.103890
State	Published - Aug 2021

Keywords

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

ASJC Scopus subject areas

Experimental and Cognitive Psychology
Clinical Psychology
Psychiatry and Mental health

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10.1016/j.brat.2021.103890

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Simpson, H. B., Foa, E. B., Wheaton, M. G., Gallagher, T., Gershkovich, M., Schmidt, A. B., Huppert, J. D., Campeas, R. B., Imms, P. A., Cahill, S. P., DiChiara, C., Tsao, S. D., Puliafico, A. C., Chazin, D., Asnaani, A., Moore, K., Tyler, J., Steinman, S. A., Sanchez-LaCay, A., ... Wang, Y. (2021). Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. Behaviour Research and Therapy, 143, Article 103890. https://doi.org/10.1016/j.brat.2021.103890

Simpson, HB, Foa, EB, Wheaton, MG, Gallagher, T, Gershkovich, M, Schmidt, AB, Huppert, JD, Campeas, RB, Imms, PA, Cahill, SP, DiChiara, C, Tsao, SD, Puliafico, AC, Chazin, D, Asnaani, A, Moore, K, Tyler, J, Steinman, SA, Sanchez-LaCay, A, Capaldi, S, Snorrason, I, Turk-Karan, E, Vermes, D, Kalanthroff, E, Pinto, A, Hahn, CG, Xu, B, Van Meter, PE, Katechis, M, Scodes, J & Wang, Y 2021, 'Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder', Behaviour Research and Therapy, vol. 143, 103890. https://doi.org/10.1016/j.brat.2021.103890

@article{a8f0ba1ef6f04a33bbc797d398761bf5,

title = "Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder",

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",

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

note = "Funding Information: We would like to thank the patients who participated in this study, the research assistants who helped (Liza Alpert, Joseph Carpenter, Stephanie Chen, Natalie Gay, Ashley Greene, Shari Lieblich, Rachel Middleton, Julie Peterson, and Marissa Schwartz), and Drs. Lily Brown and Sapana Patel who assisted with patient assessments. We also thank Dr. David Rosenfield for consulting on an earlier version of this manuscript and Ms. Gabrielle R. Messner for her help in submission of the manuscript. The study was funded by the National Institute of Mental Health ( R01MH045436 [PI: Simpson] and R01MH045404 [PI: Foa]). Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",

year = "2021",

month = aug,

doi = "10.1016/j.brat.2021.103890",

language = "English (US)",

volume = "143",

journal = "Behaviour Research and Therapy",

issn = "0005-7967",

publisher = "Elsevier Limited",

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T1 - Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder

AU - Simpson, Helen B.

AU - Foa, Edna B.

AU - Wheaton, Michael G.

AU - Gallagher, Thea

AU - Gershkovich, Marina

AU - Schmidt, Andrew B.

AU - Huppert, Jonathan D.

AU - Campeas, Raphael B.

AU - Imms, Patricia A.

AU - Cahill, Shawn P.

AU - DiChiara, Christina

AU - Tsao, Steven D.

AU - Puliafico, Anthony C.

AU - Chazin, Daniel

AU - Asnaani, Anu

AU - Moore, Kelly

AU - Tyler, Jeremy

AU - Steinman, Shari A.

AU - Sanchez-LaCay, Arturo

AU - Capaldi, Sandy

AU - Snorrason, Ivar

AU - Turk-Karan, Elizabeth

AU - Vermes, Donna

AU - Kalanthroff, Eyal

AU - Pinto, Anthony

AU - Hahn, Chang Gyu

AU - Xu, Bin

AU - Van Meter, Page E.

AU - Katechis, Martha

AU - Scodes, Jennifer

AU - Wang, Yuanjia

N1 - Funding Information: We would like to thank the patients who participated in this study, the research assistants who helped (Liza Alpert, Joseph Carpenter, Stephanie Chen, Natalie Gay, Ashley Greene, Shari Lieblich, Rachel Middleton, Julie Peterson, and Marissa Schwartz), and Drs. Lily Brown and Sapana Patel who assisted with patient assessments. We also thank Dr. David Rosenfield for consulting on an earlier version of this manuscript and Ms. Gabrielle R. Messner for her help in submission of the manuscript. The study was funded by the National Institute of Mental Health ( R01MH045436 [PI: Simpson] and R01MH045404 [PI: Foa]). Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021/8

Y1 - 2021/8

N2 - 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.

AB - 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.

KW - CBT

KW - Cognitive-behavioral therapy

KW - EX/RP

KW - Exposure and ritual prevention

KW - OCD

KW - Obsessive-compulsive disorder

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UR - http://www.scopus.com/inward/citedby.url?scp=85107136862&partnerID=8YFLogxK

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DO - 10.1016/j.brat.2021.103890

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SN - 0005-7967

VL - 143

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

M1 - 103890

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

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