Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 576 words

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Abstract :

Keywords Obsessive-compulsive disorder; OCD; Exposure and ritual prevention; EX/RP; Cognitive-behavioral therapy; CBT Highlights * We tested EX/RP as an SRI augmentation strategy for adults with OCD. * Extending EX/RP from 17 to 25 sessions of EX/RP enabled 69.3% of patients to achieve remission. * Patient adherence, OCPD traits, and BDNF genotype influenced the odds and timing of remission. Abstract Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score [greater than or equal to]18) despite an adequate SRI trial ([greater than or equal to]12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS [less than or equal to]12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall. Author Affiliation: (a) Department of Psychiatry, Columbia University, New York, NY, 10032, USA (b) New York State Psychiatric Institute, New York, NY, 10032, USA (c) Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA (d) Barnard College, Columbia University, New York, NY, 10027, USA (e) The Hebrew University of Jerusalem, Israel (f) University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA (g) Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA (h) Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA (i) Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA (j) Department of Psychology, WVU, Morgantown, WV, 26506, USA (k) McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA (l) Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA (m) Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA * Corresponding author. 1051 Riverside Drive Unit 69, New York, NY, 10032, USA. Article History: Received 11 December 2020; Revised 31 March 2021; Accepted 18 May 2021 (footnote)1 PI of grants (R01MH045436 and R01MH045404) and contributed equally. Byline: Helen B. Simpson [Blair.Simpson@nyspi.columbia.edu] (a,b,*,1), Edna B. Foa (c,1), Michael G. Wheaton (b,d), Thea Gallagher (c), Marina Gershkovich (a,b), Andrew B. Schmidt (a,b), Jonathan D. Huppert (e), Raphael B. Campeas (a,b), Patricia A. Imms (c), Shawn P. Cahill (f), Christina DiChiara (c,g), Steven D. Tsao (c,g), Anthony C. Puliafico (a,b), Daniel Chazin (c), Anu Asnaani (c,h), Kelly Moore (c,i), Jeremy Tyler (c), Shari A. Steinman (a,b,j), Arturo Sanchez-LaCay (a,b), Sandy Capaldi (c), Ivar Snorrason (a,b,k), Elizabeth Turk-Karan (c), Donna Vermes (a,b), Eyal Kalanthroff (e), Anthony Pinto (a,b,l), Chang-Gyu Hahn (c), Bin Xu (a), Page E. Van Meter (a,b), Martha Katechis (a,b), Jennifer Scodes (b), Yuanjia Wang (m)

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Gale Document Number: GALE|A665686089