Project Results

I am excited to share some very preliminary pilot results regarding the novel intervention strategy we have developed for this project. The intervention involves guiding patients to notice and reflect on the therapeutic value of practicing what we have termed "cognitive integrity" - that is, being actively honest with oneself. So far we have collected data from 12 patients with OCD and/or related anxiety disorders who completed our 30-minute adjunct intervention prior to one of their regularly scheduled exposure-based therapy sessions. In short, patients reported finding our adjunct intervention helpful at increasing their motivation and persistence during the subsequent exposure session. The patients' therapists also reported that the patients engaged more fully (t(11)=2.80, p=.017) and showed more willingness to experience emotional discomfort during exposure (t(11)=3.53, p=.005) following our adjunct intervention than they had in previous sessions. Patients also provided some helpful qualitative feedback on our adjunct intervention, from which we quote some anonymized excerpts below: 

“I really found the advice about the importance of being honest with yourself helpful. I had some homework that I did not fully complete and I will often just claim to have completed something even if I haven’t because I want to show the appearance of making progress. This discussion made me think hard about the difference between actually accomplishing something vs. just appearing to accomplish something.”

“I think that using personal honesty when it comes to pushing as hard as possible in completing exposures can be an effective motivator. The effectiveness could vary depending on the difficulty of the exposure at hand and if there are any distractions that are diverting focus."

“I thought it was helpful to speak about the importance of recognizing passive avoidance when completing exposure tasks. While I knew [my therapist] and I were going to discuss it anyway and I have always been pretty cognizant of it, it was great to hear it an additional time to keep it at the forefront of my mind."

“I think it was helpful for me to find an example of when I struggled with doing something that made me uncomfortable, but did it anyway. Remembering how that felt, to get through the experience that I didn't want to do, should be helpful for me to encourage and motivate myself to work through the exposures that I'm doing now. And also to recognize the excuses that I made and to challenge them.”

About This Project

The efficacy of exposure-based therapies for obsessive compulsive disorder (OCD) is among the most well-established findings in clinical psychology. Yet non-response rates are still alarmingly high, with 40% of patients either quitting early or not benefiting. This project will test two theoretically plausible predictors of OCD patients' persistence during treatment, and whether modifying one or both factors can improve treatment outcomes.

Ask the Scientists

What is the context of this research?

Obsessive compulsive disorder (OCD) symptoms affect as many as 1 in 4 people and are often extremely debilitating. The gold-standard treatment for OCD is exposure and response prevention (ERP), which involves willingly confronting situations one finds distressing (e.g., a dirty, grimy toilet) and resisting the urge to ritualize (e.g., wash one's hands) in response. ERP works extremely well for most patients who get through it successfully; yet 20% of patients drop out early, and another 20% "fail" to benefit. Thus more work is needed to understand why ERP works for some patients and not others, and to improve or tailor our treatment approaches accordingly.

What is the significance of this project?

The success of ERP hinges on patients' ability to exercise self-control in the face of powerful urges to act on their compulsions. Yet self-control is likely impaired in OCD, making this especially difficult. This project will aim to enhance ERP treatment outcomes by strengthening 2 facets of self-control: autonomous motivation (i.e., tying ERP to one's freely chosen goals and values) and working memory (i.e., keeping goal-related information active in memory during a complex task). This will be the first test of whether modifying one or both factors can improve ERP outcomes, thus paving the way to more effective treatments for this debilitating disorder.

What are the goals of the project?

Our goal is to test 2 novel factors that we think may affect patients' ability to stick with, and ultimately benefit from, ERP treatment: their self-reported level of autonomous motivation for treatment, and their performance on a computerized working memory task. We will first test these factors in 100 OCD patients just starting ERP treatment at either a residential or outpatient facility. We will then randomly assign patients to either working memory (WM) training, motivation enhancement (ME), combination (WM+ME), or a placebo control (with "training" on an unrelated task), and will compare their effects on ERP adherence and symptom reduction over treatment.