Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial

Joseph A Himle; Andrew Grogan-Kaylor; Matthew A Hiller; Kristin A Mannella; Luke J Norman; James L Abelson; Aileen Prout; Angela A Shunnarah; Hannah C Becker; Stefanie R Russman Block; Stephan F Taylor; Kate D Fitzgerald

doi:10.1016/j.brat.2023.104458

Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial

Behav Res Ther. 2024 Jan:172:104458. doi: 10.1016/j.brat.2023.104458. Epub 2023 Dec 12.

Affiliations

¹ School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA. Electronic address: himlej@umich.edu.
² School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA.
³ Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
⁴ Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA.

Abstract

Objective: Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT).

Methods: This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups.

Results: ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ² = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ² = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP.

Conclusion: A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.

Trial registration: ClinicalTrials.gov NCT02437773.

Keywords: Adolescents; Adults; Exposure and response prevention; Obsessive compulsive disorder; Stress management.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Child
Humans
Obsessive-Compulsive Disorder* / diagnosis
Obsessive-Compulsive Disorder* / therapy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02437773

Grants and funding

R01 MH102242/MH/NIMH NIH HHS/United States