4 - (SYM 90) Consumer Perspectives on Justice-based ERP for OCD with Identity-related Themes

Background: Justice-based exposure and response prevention (ERP) is a lens through which identity-related OCD themes (e.g., sexual orientation, racism, disability) can be treated effectively and sensitively to prevent further marginalization of vulnerable communities. This approach, described in Pinciotti et al. (2022), has gained momentum in the OCD community, however research has yet to examine consumer perspectives on the approach compared to traditional ERP. This study is the first to empirically examine consumers’ perceived effectiveness, relevance, and buy-in for justice-based ERP.

Methods: A total of 394 adults with OCD (Mage = 33.3, SD = 11.4; 86.6% female; 81.2% White; 58.7% heterosexual) were recruited to complete a 10-minute online survey. Participants who endorsed identity-related symptoms were given brief psychoeducation about ERP and then provided two exposure hierarchies based on their symptoms endorsed – one justice-based and one traditional. Sequence of justice-based and traditional exposure hierarchies was counterbalanced. Nine items followed, rated from 0 to 4, regarding participants’ perspectives on each hierarchy.

Results: Overall, participants with identity-related OCD preferred the justice-based ERP hierarchies (M = 1.93, SD = 0.75) to the traditional hierarchies (M = 1.22, SD = 0.87; t [286] = 13.54, d = 0.88). Among the largest effects (all p < .001), participants found the traditional hierarchies more derogatory (M = 2.11, SD = 1.22) compared to the justice-based hierarchies (M = 0.42, SD = 0.71; t [293] = -22.63, d = -1.32); were more willing to do justice-based ERP exposures with a therapist (M = 2.19, SD = 1.12) compared to traditional ERP exposures (M = 1.31, SD = 1.19; t [290] = 12.69, d = 0.74); and were more willing to do justice-based ERP exposures in front of the target demographic (M = 2.07, SD = 1.19) compared to the traditional ERP exposures (M = 0.94, SD = 1.08; t [290] = 15.05, d = 0.88).

Discussion: Justice-based ERP is theorized to effectively target identity-related OCD themes without further marginalizing marginalized communities. Findings provide support for the effectiveness of justice-based ERP, as individuals with these themes had greater buy-in and willingness to complete these exposures, while also indicating that these exposures were more relevant and effective for their OCD. Individuals with identity-related OCD may be more likely to seek ERP treatment, less likely to drop out, and more likely to experience benefit from ERP if exposures are developed through a justice-based ERP lens.