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

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.

A randomized controlled trial of acceptance and commitment therapy for clinical perfectionism

“…Psychological inflexibility has also been associated with problematic behaviors related to clinical perfectionism such as eating disorders, obsessive-compulsive and related disorders, depression, and anxiety disorders (A-Tjak et al, 2015;Powers, Zum Vorde Sive Vording, & Emmelkamp, 2009), further suggesting clinical perfectionism may be treated by improving psychological flexibility. Other support for this hypothesis comes from clinical trials demonstrating positive outcomes from ACT for multiple behavioral problems related to clinical perfectionism, including obsessive-compulsive disorder (OCD; Twohig et al, 2018;Twohig et al, 2010), trichotillomania (Lee et al, 2018), anxiety and depression (Arch et al, 2012;Forman, Herbert, Moitra, Yeomans, & Geller, 2007), and problematic eating (Juarascio, Forman, & Herbert, 2010). However, ACT has not been specifically tested as a treatment for clinical perfectionism.…”

Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions

“…Participants in the present study were 52 treatment‐seeking adults with a DSM‐5 primary diagnosis of OCD who participated in a randomized controlled trial comparing traditional exposure and response prevention (ERP) with ERP conducted within an ACT framework (ACT + ERP). The methods of the parent trial are described in detail by Twohig et al (). Initially, 74 individuals were assessed to determine eligibility to participate in the parent trial.…”

“…Initially, 74 individuals were assessed to determine eligibility to participate in the parent trial. Sixteen did not meet eligibility criteria and were excluded at the initial intake visit (see Twohig et al, for an explanation for exclusions). Fifty‐eight individuals with a primary or coprimary diagnosis of OCD were enrolled and randomized to treatment.…”

Acceptance and commitment therapy for a case of scrupulosity-related obsessive-compulsive disorder

“…This is likely due to lack of clinical trials from independent research laboratories. There have been two randomized trials out of the United State of America (Twohig et al, 2018;Twohig et al, 2010), as well as four trials out of Iran (Baghooli, Dolatshahi, Mohammadkhani, Moshtagh, & Naziri, 2014;Esfahani, Kjbaf, & Abedi, 2015;Rohani et al, 2018;Vakili, Gharraee, Habibi, Lavasani, & Rasoolian, 2014), including work in both countries with children and adolescents (Armstrong, Morrison, & Twohig, 2013;Barney, Field, Morrison, & Twohig, 2017;Shabani et al, under review). While multiple single case studies have been completed with ACT and OCD (e.g., Twohig, Hayes, Masuda, 2016) the most pertinent was one with five adults with scrupulosity (Dehlin, Morrison, & Twohig, 2013).…”

“…Treatment consisted of 20 sessions that closely followed an ACT for OCD treatment protocol used in previous research (Twohig et al, 2010;Twohig et al, 2018). that had been customized to for scrupulosity in another study (Dehlin, Morrison, & Twohig, 2013).…”