Trauma as a predictor of exposure and response prevention (Ex/RP) treatment outcomes for patients with obsessive-compulsive disorder (OCD) in a clinical setting

Philadelphia, PA

Background: Trauma has been found to be highly prevalent among individuals diagnosed with obsessive-compulsive disorder (OCD) and to impact the onset, maintenance, and severity of OCD symptoms. Little is known, however, about how trauma might affect outcomes for individuals engaging in exposure and response prevention (Ex/RP). Despite Ex/RP being the most widely implemented treatment for OCD, lack of consideration for psychosocial factors, like experienced trauma, has been cited as a possible limitation of the treatment. Furthermore, intolerance of uncertainty (IU), anxiety sensitivity (AS), and emotion regulation (ER) are transdiagnostic variables most commonly associated with the presence of posttraumatic stress and OCD treatment success, respectively, however, no research to date has identified whether such variables might be implicated in the relationship between trauma and Ex/RP treatment outcomes.

Objective: The primary aim of this study is to investigate how trauma might predict Ex/RP treatment outcomes for patients with OCD. The questions this study seeks to answer are: (1) Do OCD patients with trauma experience more severe OCD symptoms, IU, AS, and ER at pretreatment, compared to those without trauma? (2) Do the variables (i.e., IU, AS, and ER) mediate the relationship between trauma and Ex/RP treatment outcomes?

Methods: Analyses of archival data will be performed on pretreatment and posttreatment measures of treatment-seeking patients with a primary OCD at a specialty anxiety clinic. Based on patient self-report on the Posttraumatic Diagnostic Scale for the DSM-5 (PDS-5; Foa, 2013) OCD patients will be separated into two groups: (1) those reporting no trauma experiences (OCD group), and (2) those reporting at least one trauma experience (OCDT group). A MANOVA will be used to assess whether the OCDT group report more severe OCD symptoms, IU, AS, and ER at pretreatment, compared to the OCD group. Second, based on those findings, a mediation analysis will be used to assess whether the variable found to differ most significantly between the groups (IU, AS, & ER) mediate the relationship between trauma and Ex/RP outcomes (severity change scores) at posttreatment.

Discussion: Findings from this study have the potential to inform clinical practice around the assessment of OCD symptom presentation and the need to consider the impact of trauma and related transdiagnostic variables in the implementation of Ex/RP treatment to provide greater opportunity for successful treatment outcomes.