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Randomized Controlled Trial
. 2024 Jan:172:104458.
doi: 10.1016/j.brat.2023.104458. Epub 2023 Dec 12.

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

Joseph A Himle  1 , Andrew Grogan-Kaylor  2 , Matthew A Hiller  2 , Kristin A Mannella  3 , Luke J Norman  3 , James L Abelson  3 , Aileen Prout  3 , Angela A Shunnarah  3 , Hannah C Becker  3 , Stefanie R Russman Block  3 , Stephan F Taylor  3 , Kate D Fitzgerald  4
Affiliations
Randomized Controlled Trial

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

Joseph A Himle et al. Behav Res Ther. 2024 Jan.

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.

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Conflict of interest statement

Declaration of competing interest Declarations of interest: none.

Figures

Fig. 1.
Fig. 1.
Consort diagram.
Fig. 2.
Fig. 2.
OCD symptoms over time and treatment for combined youth and adult sample.
See this image and copyright information in PMC

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