What predicts improvement and compliance during the behavioral treatment of obsessive compulsive disorder?

Abstract

The aim of the study was to identifi factors associated with treatment compliance and clinical improvement when obsessive compulsive disorder is treated with graded exposure and response prevention. The sample consisted of all patients with a diagnosis of obsessive compulsive disorder admitted over a 3-year period to a unit specialising in behavioral treatment. All subjects were diagnosed using reliable diagnostic criteria and all were followed-up for 12 months. A range of social and clinical variables was examined using stepwise regression analysis. Treatment compliance was associated with being employed during treatment and living with one's family. Clinical improvement was associated with never having been treated previously, being employed during treatment, having a fear of contamination, having overt ritualistic behaviour, the absence of depression and living with one's family. Anxiety 2:22-27 (19963. 0 1996 Wiley-Liss, Inc. n ~ ~ ~

Diagnostic interview assessed neuropsychiatric disorder comorbidity in 334 individuals with obsessive-compulsive disorder

“…Comorbid PTSD has been linked to less improvement in both depressive and obsessivecompulsive symptoms [Gershuny et al, 2002]. In particular, OCD with comorbid depression or generalized anxiety disorder is predictive of poor psychotherapy treatment outcomes [e.g., Buchanan et al, 1996;Overbeek et al, 2002;Steketee et al, 1999Steketee et al, , 2001 as well as with poor quality of life ratings [Masellis et al, 2003]. Research suggests that both cognitive and behavioral therapies produce equivalent treatment gains in obsessive-compulsive symptom reduction, although patients receiving cognitive therapy experience significantly greater reduction in depressive symptoms [Cottraux et al, 2001;Emmelkamp et al, 1988].…”

Moderators and predictors of response to cognitive-behavioral therapy augmentation of pharmacotherapy in obsessive–compulsive disorder

“…Female gender was unrelated to outcome in two studies (Foa et al 1983 a ; Steketee et al 2001). Being employed was related to a better outcome in one study (Buchanan et al 1996). By contrast, global measures of social and occupational function have not predicted EX/RP outcome in the studies reviewed (Steketee & Shapiro, 1995; Buchanan et al 1996).…”

“…Age of onset did not predict treatment outcome (Steketee & Shapiro, 1995). Longer duration of illness predicted outcome in only one study (Keijsers et al 1994), with most studies (Steketee & Shapiro, 1995; Buchanan et al 1996) showing no impact.…”

Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder

“…[43] and Keeley et al’s. [31], proceeding systematic literature reviews focused on predictive factors of treatment results in OCD, found several studies in which factors associated with a better prognosis with BT or CBT in the treatment of OCD, either associated or not with selective serotonin reuptake inhibitors (SSRI), such as: having a partner [10,49]; greater improvement by the end of treatment [8,21,41]; younger age [21]; being employed [9]; no history of prior treatment [9]; better treatment compliance [13,41]; therapeutic alliance [32]; greater patient motivation for treatment [14,32]; and complete remission of OCS with treatment [8]. Factors frequently associated with a poor prognosis were: sexual and religious obsessions [3]; hoarding [44,46]; psychiatric comorbidities [27,38]; poor insight [27,39]; early onset and chronic course of OCD [37,47]; longer illness [32]; lower income level [50]; greater baseline severity of OCS [7,14,27,32,37,51]; greater family dysfunction and negative family interactions [50]; male sex [7]; higher rates of depression [2,9,21,32,50] and severe comorbid depression [2,10,32].…”