Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Abstract

Background: Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods: This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results: Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP -the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions: MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

The Association of Trait Mindfulness and Self-compassion with Obsessive-Compulsive Disorder Symptoms: Results from a Large Survey with Treatment-Seeking Adults

“…The growing interest in MBIs (adapted) for OCD (e.g. Key et al 2017;Külz et al 2019;Selchen et al 2018;Strauss et al 2018) is informed by the fact approximately 50% of patients do not experience OCD symptom remission following cognitive behavioural therapy for OCD (Öst et al 2015). The rationale for MBIs for OCD is predicated on the assumption that poor mindfulness and self-compassion skills contribute to OCD symptoms (e.g.…”

Participant perspectives on the acceptability and effectiveness of mindfulness-based cognitive behaviour therapy approaches for obsessive compulsive disorder

“…This paper reports on two qualitative studies that explored patient perspectives on the acceptability and potential benefits of MBIs for OCD, specifically MB-ERP [49] (study 1) and MBCT adapted for OCD (MBCT-OCD) (study 2). MB-ERP was based on ERP as the primary vehicle of change but included a mindfulness skills training component aimed at enhancing engagement in ERP to improve outcomes.…”

“…MB-ERP was based on ERP as the primary vehicle of change but included a mindfulness skills training component aimed at enhancing engagement in ERP to improve outcomes. Study 2 followed on from study 1, after the pilot RCT data suggested that MB-ERP would be unlikely to improve on ERP in reducing OCD symptoms post-treatment [49]. Study 2 involved an adapted course of MBCT for OCD, positing mindfulness skills training as the primary vehicle of change in OCD symptoms; it did not involve ERP and included longer and more intensive mindfulness practice than MB-ERP.…”

“…intervention (study 1) would also help to contextualise the finding that MB-ERP did not appear to improve on ERP outcomes [49].…”

“…Quantitative studies of MBIs for OCD include a pilot RCT comparing standard ERP with Mindfulness-based ERP (MB-ERP), which integrates mindfulness practice with a standard ERP protocol [49]. The 95% confidence interval for the post-treatment between-group difference in OCD symptom reduction did not include the 5-point minimum clinically important difference in favour of MB-ERP, suggesting that a larger trial would be unlikely to show that MB-ERP outperformed ERP in terms of OCD symptom reduction.…”