Does Exposure and Response Prevention Behaviorally Activate Patients With Obsessive-Compulsive Disorder? A Preliminary Test

Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach

BACKGROUND

Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally.

METHODS

Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined.

RESULTS

Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed.

CONCLUSIONS

Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.

Is my patient too sad to approach their fear? Depression severity and imaginal exposure outcomes for patients with OCD

BACKGROUND AND OBJECTIVES

There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habituation, and interferes with adaptive learning.

METHODS

Fifty-one individuals with OCD completed a diagnostic interview and self-report questionnaires assessing depression symptom severity and then participated in a standardized imaginal exposure protocol, in which they repeatedly approached an idiosyncratic fear deemed "moderately anxiety-provoking."

RESULTS

Contrary to expectations, linear regression models indicated that depression symptom severity was not independently associated with motivation, subjective or objective within-session habituation or adaptive learning outcomes. However, the perceived likelihood of the best-case scenario occurring as a result of the exposure moderated the relationship between depression severity and motivation to engage in the exposure exercise.

LIMITATIONS

Use of a one-session exposure protocol precludes conclusions regarding how depression is associated with outcomes in a full ERP treatment.

CONCLUSIONS

Depression symptom severity was not independently associated with motivation, habituation, or adaptive learning. The observed non-significant effects suggest that degree of depression, on its own, is not a meaningful indicator of how patients with OCD will fare an exposure intervention.

The effects of depression on the treatment of OCD in a residential sample

Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment. OCD patients receiving residential treatment based primarily on exposure and response prevention (ERP) provided data regarding symptoms of depression and OCD at admission and discharge. Patients reported large and significant reductions in OCD symptoms over the course of treatment. Change in OCD symptoms was not significantly affected by depressive symptoms, including patients with severe depressive symptoms. Change in depressive symptoms over the course of treatment was, however, robustly related to change in OCD symptoms, especially among patients who began treatment with severe symptoms of depression. These findings suggest that cognitive-behavior therapy delivered in a residential treatment setting drastically reduces OCD symptoms regardless of depressive symptoms.