title: A brief motivational intervention for treatment-refusing OCD patients.
abstract: Cognitive behavioral therapy involving exposure and response prevention (ERP) is the psychosocial treatment of choice for obsessive-compulsive disorder (OCD). Despite this, ERP is not widely used by mental health practitioners, and so dissemination of ERP and other empirically supported treatment (ESTs) has become a priority. Even so, utilization of ESTs such as ERP remains below 50% even among therapists who self-identify as having a cognitive behavioral orientation. Barriers to the acceptance of ERP include practical obstacles such as lack of training and the cost of treatment, but also patient variables such as treatment refusal. It has been estimated that approximately 25% of OCD patients refuse ERP. This paper describes a brief, 4-session readiness intervention (RI) designed to decrease ERP refusal among patients with OCD. In this study, 12 patients with OCD who had refused ERP were randomized to RI or wait-list (WL). 86% of participants in the RI condition and 20% of participants in WL condition agreed to begin ERP following the 4-week period. ERP following RI, but not WL, was associated with a decrease in OCD symptoms comparable to that observed in OCD patients who did not refuse ERP. However, ERP following RI was associated with a high drop-out rate (50%), a figure that exceeds that typically seen in OCD treatment studies. Techniques to reduce drop-out as well as directions for future research are discussed.
authors.affiliation: The Institute of Living, Hartford Hospital, Hartford, CT 06106, USA. nmaltby@harthosp.org
authors.forename: Nicholas
authors.initials: N
authors.lastname: Maltby
authors.forename: David F
authors.initials: DF
authors.lastname: Tolin
mesh_terms: D000328:Adult; D003887:Desensitization, Psychologic; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011614:Psychotherapy, Brief / Q000379:methods*; D016037:Single-Blind Method; D016312:Treatment Refusal / Q000523:psychology