title: Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial.
abstract: BACKGROUND
  Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them.
  
  
  METHODS
  This is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnosed with OCD will be allocated at random to a 10-session ERP group or to a 10-session MB-ERP group. Primary outcomes are OCD symptom severity and therapy engagement. Secondary outcomes are depressive symptom severity, wellbeing and obsessive-compulsive beliefs. A semi-structured interview with participants will guide understanding of change processes.
  
  
  CONCLUSIONS
  Findings from this pilot study will inform future research in this area, and if effect sizes on primary outcomes are in favour of MB-ERP in comparison to ERP, funding for a definitive trial will be sought.
  
  
  BACKGROUND
  Current Controlled Trials registration number ISRCTN52684820. Registered on 30 January 2014.
authors.affiliation: School of Psychology, University of Sussex, Pevensey Building, Falmer, BN1 9QH, Brighton, UK. c.y.strauss@sussex.ac.uk.|Sussex Partnership NHS Foundation Trust, R&D Department, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK. c.y.strauss@sussex.ac.uk.
authors.forename: Clara
authors.initials: C
authors.lastname: Strauss
authors.affiliation: Centre for Health Research, University of Brighton, 266 Mayfield House, Village Way, Falmer, Brighton, BN1 9PH, UK. C.E.Rosten@brighton.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Rosten
authors.affiliation: School of Psychology, University of Sussex, Pevensey Building, Falmer, BN1 9QH, Brighton, UK. mih21@sussex.ac.uk.|Sussex Partnership NHS Foundation Trust, R&D Department, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK. mih21@sussex.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Hayward
authors.affiliation: Sussex Partnership NHS Foundation Trust, R&D Department, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK. laura.lea@sussexpartnership.nhs.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: Lea
authors.affiliation: Independent Consultant Clinical Psychologist, London, UK. dreforrester@btinternet.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Forrester
authors.affiliation: Sussex Partnership NHS Foundation Trust, R&D Department, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ, UK. A.Jones4@brighton.ac.uk.|Centre for Health Research, University of Brighton, 266 Mayfield House, Village Way, Falmer, Brighton, BN1 9PH, UK. A.Jones4@brighton.ac.uk.
authors.forename: Anna-Marie
authors.initials: AM
authors.lastname: Jones
mesh_terms: D002985:Clinical Protocols; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004739:England; D006801:Humans; D007171:Implosive Therapy; D057194:Intention to Treat Analysis; D007407:Interviews as Topic; D064866:Mindfulness; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010352:Patient Dropouts; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome