title: The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive-compulsive disorder.
abstract: OBJECTIVE
  Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients.
  
  
  METHODS
  The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores.
  
  
  RESULTS
  The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β=.27, p=.02) and hoarding dimensions (β=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores.
  
  
  CONCLUSIONS
  EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
authors.affiliation: University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA. Electronic address: m.williams@louisville.edu.
authors.forename: Monnica T
authors.initials: MT
authors.lastname: Williams
authors.affiliation: University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
authors.forename: Samantha G
authors.initials: SG
authors.lastname: Farris
authors.affiliation: University of Virginia, Department of Psychology, 102 Gilmer Hall, Box 400400, Charlottesville, VA 22904, USA.
authors.forename: Eric N
authors.initials: EN
authors.lastname: Turkheimer
authors.affiliation: University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Franklin
authors.affiliation: Columbia University, Department of Psychiatry, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY 10032, USA; New York State Psychiatric Institute, Division of Clinical Therapeutics, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA.
authors.forename: H Blair
authors.initials: HB
authors.lastname: Simpson
authors.affiliation: Columbia University, Department of Psychiatry, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY 10032, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebowitz
authors.affiliation: University of Pennsylvania, School of Medicine, Department of Psychiatry, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000293:Adolescent; D000328:Adult; D002562:Ceremonial Behavior; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005163:Factor Analysis, Statistical; D005260:Female; D000067836:Hoarding Disorder; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000517:prevention & control* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013850:Thinking; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Exposure and response prevention; Factor analysis; Hoarding; Obsessive-compulsive disorder; Symptom dimensions; Treatment outcome