Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial

doi:10.1016/j.brat.2018.06.005

Behaviour Research and Therapy

Volume 108, September 2018, Pages 1-9

https://doi.org/10.1016/j.brat.2018.06.005 Get rights and content

Highlights

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Adding ACT to Exposure with Response Prevention (ERP) did not improve acceptability, engagement, or drop-out for OCD.
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ACT plus ERP and ERP alone both had high acceptability, engagement, and low drop-out.
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ACT plus ERP and ERP alone were both highly effective for OCD with no difference in outcomes.

Abstract

The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological inflexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement.

Section snippets

Participants

Fifty-eight adults who met DSM-IV criteria for a principal or co-principal diagnosis of OCD were randomized to either standard ERP (n = 28) or ACT + ERP (n = 30). An additional 16 participants were identified as ineligible at intake and excluded from the study. We used a modified intent-to-treat (ITT) approach that included all participants who began treatment and did not include six who dropped out of the study prior to treatment initiation (before being informed of their randomly assigned

Preliminary analyses

Table 1 shows the sociodemographic characteristics of the two groups. A series of t-tests and chi-square tests (also presented in Table 1) failed to detect any significant group differences, suggesting successful randomization. There were no between-group differences in co-occurring clinical diagnoses or in the proportion of participants using psychotropic medication.

Table 2 displays the means and standard deviations on all clinical variables for both groups at pretreatment, posttreatment, and

Discussion

Although ERP is an effective treatment for OCD, it is important to identify methods to improve patient adherence, completion, and outcome. For a number of conceptual and practical reasons (as articulated previously), integrating ACT and ERP provides a promising avenue for addressing these aims. Accordingly, this investigation tested the differential efficacy of traditional ERP versus ACT + ERP. As predicted, participants in both conditions showed substantial pre-to post-treatment decreases in

Summary and conclusion

This study represents the first randomized controlled trial comparing traditional ERP to ACT + ERP. Despite differences in the rationale and implementation of ERP, the overall findings are characterized by similarities in the immediate and long-term outcomes, acceptability and engagement, and theoretical processes of change in both approaches. In concert with previous work (Arch et al., 2012; Fabricant, Abramowitz, Dehlin, & Twohig, 2013; Wolitzky-Taylor, Arch, Rosenfield, & Craske, 2012), this

Author note

This study was funded by a grant from the International OCD Foundation. This trial was registered with clinicaltrials.gov under the protocol ID 2965. Manuals or other information are available from the corresponding author. Please address correspondence to Michael Twohig, Ph.D. at [email protected].

Conflict of interests

We have no conflict of interests to report.

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Published by Elsevier Ltd.

Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial

Highlights

Abstract

Section snippets

Participants

Preliminary analyses

Discussion

Summary and conclusion

Author note

Conflict of interests

Behaviour Research and Therapy

Journal of Obsessive-compulsive and Related Disorders

Behavior Therapy

Behaviour Research and Therapy

Journal of Anxiety Disorders

Journal of Behavior Therapy and Experimental Psychiatry

Clinical Psychology Review

Journal of Contextual Behavioral Science

Clinical Psychology Review

Behavior Therapy

Clinical Psychology Review

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Psychiatric Research

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Behavior Therapy

Behaviour Research and Therapy

Cognitive and Behavioral Practice

Cognitive and Behavioral Practice

Journal of Obsessive-compulsive and Related Disorders

Behavior Therapy