(PS2-98) Values in Exposure and Response Prevention for Obsessive-compulsive Disorder

Despite the efficacy of exposure and response prevention (ERP) for obsessive compulsive disorder (OCD), a significant portion of individuals fail to benefit from this treatment and mechanisms of change warrant further investigation. Up to 30% of patients drop out of treatment prematurely (Franklin et al., 2000; Ong et al., 2016) and a substantial percentage of patients that complete ERP (14-31%) are classified as non-responders (Foa et al., 2005; Norberg et al. 2008). Thus, identifying factors that increase treatment acceptability, adherence, and response represents an important objective for the field. Theory and research suggest that personal values can be leveraged to influence engagement in aversive tasks more generally (Herbert et al., 2021) and can be successfully integrated into ERP (Twohig et al., 2018). Future research is needed to better understand how leveraging values during exposure influences treatment-related processes and outcomes.

Participants were 248 adult patients receiving intensive residential treatment (IRT) for OCD. 51.0% of patients identified as female, with a mean age of 30.05 (SD = 10.77).  As part of treatment, each patient engaged in daily ERP and completed weekly symptom severity assessments utilizing the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Hamilton Rating Scale for Depression (HAM-D). Patient self-report and coach-reported data were collected before and after each coached ERP utilizing a self-created questionnaire. Items on the questionnaire were designed to assess the saliency of one’s personal values in exposures, willingness to engage in ERP, exposure plan adherence, and ritual prevention during exposures. A series of random intercept crossed-lagged panel models were used to examine the relationships between the saliency of personal values, treatment-related variables, and symptom severity across ten weeks of IRT.

The saliency of values in exposures was relatively high across all ten time points (weekly means ranging from 3.58-3.82 out of 4.00) and did not predict treatment-related variables or OCD symptom severity, although these constructs were correlated within various time points. However, significant cross-lagged paths involving symptoms of depression were observed across all time points. Depressive symptoms at week k were negatively and significantly associated with willingness to engage in ERP at week k + 1 and vice versa. Positive and significant relationships were observed between depressive symptoms at week k and ritual engagement during ERP and OCD symptom severity at week k + 1 and vice versa.

While personal values were salient in treatment, the degree to which they were salient did not predict treatment-related variables or OCD symptom severity in the current sample. The relative stability of this variable between patients and over time may have limited its predictive ability and contributed to the non-significant findings in the RI-CLPMs. Importantly, findings highlight reciprocal relationships between depressive symptoms and both ERP related variables and OCD symptom severity over the course of treatment. Clinical implications and future directions will be discussed.