Does the network structure of obsessive-compulsive symptoms at treatment admission identify patients at risk for non-response?

Abstract

Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symptoms and, ultimately, how to target those associations in treatment. In a large sample of patients who completed intensive treatment for OCD and related disorders (N = 1343), we examined whether differences in network structure of OCD symptom aspects existed at baseline between treatment responders versus non-responders. A network comparison test indicated a significant difference between OCD network structure for responders versus non-responders (M = 0.19, p = .02). Consistent differences emerged between responders and non-responders in how they responded to emotional distress. This pattern of associations suggests that non-responders may have been more reactive to their distress by performing compulsions, thereby worsening their functioning. By examining the association between baseline distress intolerance with other symptom aspects that presumably maintain the disorder (e.g., ritualizing), clinicians can more effectively target those associations in treatment.

Keywords: Distress tolerance; Exposure and response prevention; Network analysis; Treatment refractory; obsessive Compulsive disorder.

Figure 1

Estimated Regularizes Partial Correlation Network of OCD Symptom Aspects among Responders and Non-Responders Note. Estimated regularized partial correlation network of OCD symptoms among Responders (left) and Non-Responders (right) in full sample. Responders were defined as individuals with ≥ 35% reduction from baseline YBOCS scores.

Figure 2

Strength Centrality for OCD Symptom Aspects among Responders and Non-Responders Note. Strength centrality for OCD symptom aspects among Responders (left) and Non-Responders (right) in full sample. Responders were defined as individuals with ≥ 35% reduction from baseline YBOCS scores.

Figure 3

Bootstrapped 95% Confidence Intervals for Edge Weights Connecting OCD Symptom Aspects in Responders and Non-Responders Note. Nonparametric bootstrapped 95% confidence intervals for edge weights in Responders (left) and Non-Responders (right). Responders were defined as individuals with ≥ 35% reduction from baseline YBOCS scores. Strongest edge weights appear on the topic of the figure, with smallest edge weights at the bottom. The red line represents the sample values for each edge, with confidence intervals shown in grey.

Figure 4

Network Stability among Responders and Non-Responders Note. Mean correlations between strength centrality indices of networks sampled with different percentages of cases dropped for Responders (left) and Non-Responders (right). Responders were defined as individuals with ≥ 35% reduction from baseline YBOCS scores. The line indicates the mean correlations between the subsample and original sample, whereas the shaded area indicates the range from the 2.5th quantile to the 97.5th quantile.