Effectiveness of Exposure/Response Prevention plus Eye Movement Desensitization and Reprocessing in Reducing Anxiety and Obsessive-Compulsive Symptoms Associated with Stressful Life Experiences: A Randomized Controlled Trial

Abstract

Background: Obsessive-compulsive disorder (OCD) is known as a non-psychotic mental disorder resistant to treatment. It has been found that eye movement desensitization and reprocessing (EMDR) can increase the effectiveness of its standard treatments. Objectives: The current study aimed at evaluating the impact of exposure/response prevention (ERP) combined with EMDR as a treatment method on patients with OCD who had experienced stressful life events by comparison to ERP alone. Methods: The present randomized controlled trial was conducted among 60 OCD patients who experienced stressful life events and were resistant to medication treatment. The participants were randomly assigned to the ERP plus EMDR (n = 30) and ERP (n = 30) groups. The Yale-Brown Obsessive-Compulsive scale (Y-BOCS) and Beck Anxiety Inventory (BAI) were completed before and after the intervention, as well as, after a follow-up period of three months. The scores were compared using the chi‐squared test, analysis of covariance (ANCOVA), and repeated measures analysis of variance (ANOVA). Results: ANOVA results demonstrated that both treatment protocols had a significant effect on the reduction of anxiety and severity of OCD symptoms, while the results of ANCOVA showed a significantly higher effect of ERP plus EMDR compared to the ERP protocol (P = 0.001), and sample attrition was significantly higher in the ERP group (P < 0.05). Conclusions: The ERP plus EMDR protocol compared to the ERP protocol showed a higher rate of completion and efficacy in OCD treatment.

Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy

“…All 13 articles reporting CBT use included RCTs in which patients who received standard CBT had lower Y-BOCS scores post-treatment than pre-treatment compared to control conditions, all of which were psychotherapeutic interventions (35% to 93.8% of responders had significantly improved obsessive compulsive symptoms according to Y-BOCS scores). In these 13 studies, CBT was compared to the following control interventions: supportive therapy 58 (PEDro score = 9); self-help 57 (CBT Cohen’s d = 3.75; self-help Cohen’s d = 0.77, and waiting list Cohen’s d = -0.11) (PEDro score = 9); eye movement desensitization and reprocessing 30 ( η 2 = 0.296) (PEDro score = 6); acceptance and commitment therapy 36 (ERP: Cohen’s d = 2.498, and acceptance and commitment therapy + ERP (Cohen’s d = 0.113) (PEDro score = 10); danger ideation reduction therapy 37 (danger ideation reduction therapy pre- and post-treatment comparison: Cohen’s d = 1.811; ERP pre and post-treatment comparison: Cohen’s d = 4.801) (PEDro score = 8); and an inference-based approach 40 (Cohen’s d = 0.3) (PEDro score = 9). Two of these studies tested mindfulness (Kulz et al 55 : η 2 p = 0.053; p = 0.036; Rupp et al 29 : Cohen’s d = 0.53) (PEDro score = 9; 11) and another tested “association splitting” vs. cognitive remediation 54 ( η 2 p = 0.024) (PEDro score = 8) as add-on therapies, although none of the results supported the effectiveness of these treatment options; all tested interventions differed from CBT without significant effect sizes.…”

“…Group or individual CBT therapy was proven to be as or more effective than other psychological treatments, such as mindfulness, 29 acceptance and commitment therapy, 36 or EMDR. 30 The number of weekly sessions ranged from 12 to 16, lasting from 60 to 120 minutes each, except intensive treatment (24), in which 4 to 8 hours of treatment were provided on 4 consecutive days.…”

“…It is interesting to note that adherence to CBT plus medication (range: 63%-100%) 11 , 32 - 35 , 38 , 39 , 48 - 53 , 60 was similar to adherence to CBT alone (range: 63%-100%). 29 , 30 , 36 , 40 , 44 , 46 , 54 , 55 , 57 , 58 , 62 However, when CBT is conducted via the Internet (with or without a therapist), the level of adherence decreases, with dropout levels ranging from 20%-60%. 31 , 41 - 43 , 56 , 61 The PEDro scores for all relevant RCTs were between 7 and 11, demonstrating high methodological quality.…”

Examination of Initial Evidence for EMDR as a Treatment for Obsessive-Compulsive Disorder

“…They found that both groups significantly reduced OCD symptoms at posttreatment and 6-month follow-up, and that there were no differences between the EMDR and ERP groups. Similarly, Sarichloo et al (2020) compared the effectiveness of EMDR combined with ERP (EMDR + ERP) and ERP alone on a sample of medication-resistant OCD patients with a history of trauma. They found that although both groups resulted in a reduction of OCD symptoms, the EMDR + ERP group was more effective in reducing symptoms.…”