Symposia
Treatment - CBT
Frederick Aardema, Ph.D.
University of Montreal
Montreal, Quebec, Canada
Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder, characterized by obsessional thoughts that cause patients to perform time-consuming and distressing compulsive rituals. Exposure and response prevention (ERP) is a first-line psychological treatment of choice, which requires patients to face their fears by being exposed to feared stimuli. ERP has been shown to reduce symptoms among those who comply with treatment, but not everyone improves, and residual symptoms typically remain. However, ERP has traditionally been considered a difficulty treatment and a significant proportion of patients refuse or drop out of treatment. Even among those that are able to adhere to treatment and improve, residual symptoms typically remain, which are associated with a higher risk for relapse. In particular, ERP may not be suitable for certain subgroups of clients, especially those with high levels overvalued ideation. These patients believe their obsessions are realistic and reasonable despite ego-dystonic repercussions from their belief in the reality of the obsession. Inference-based cognitive-behavior therapy (I-CBT) is a treatment without exposure that has previously been shown to be as effective as ERP with the potential to overcome some of its limitations. Unlike standard CBT treatments, I-CBT specifically addresses the obsession and its underlying reasoning that gives rise to symptoms, including overinvestment into the obsession. The current presentation presents preliminary results (N=100) from a non-inferiority randomized controlled trial comparing ERP and ICBT among those with OCD conducted during COCID-19 (ClinicalTrials.gov Identifier: NCT03677947). The hypotheses were that I-CBT is non-inferior to ERP; I-CBT is superior to ERP among OCD patients with higher levels of overvalued ideation, and ICBT is more tolerable than ERP with lower rates of treatment refusal, drop-out and higher levels of acceptability, tolerability and treatment satisfaction in comparison to ERP.