Exposure therapy in patients with harm-related obsessive-compulsive disorder: The theory-practice gap and its relation to experiential avoidance and negative beliefs about exposure

IF 1.9 4区医学 Q3 PSYCHIATRY

Journal of Obsessive-Compulsive and Related Disorders Pub Date : 2024-01-01 DOI:10.1016/j.jocrd.2024.100860

Lena Jelinek , Alicia Balzar , Steffen Moritz , Sarah Liebherz , Amir H. Yassari

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Abstract

Despite its efficacy and effectiveness, exposure with response prevention (ERP) is underused in patients with obsessive-compulsive disorder (OCD). As this underuse of ERP may apply particularly to harm-related OCD, we investigated the theory-practice gap as well as negative beliefs and experiential avoidance as potential reasons for the underutilization of ERP with this group in a sample of trainee and qualified therapists.

We assessed 339 therapists’ general knowledge about ERP using a harm-related OCD case example and their utilization of ERP in clinical practice for harm-related OCD. Of the total sample, 74% of the therapists (n = 251) were CBT-oriented and 61% (n = 209) were in training. We assessed negative beliefs and experiential avoidance using the Therapist Beliefs about Exposure Scale (TBES) and the Acceptance and Action Questionnaire-II (AAQ-II).

While 74% of the therapist recommended ERP for the case example, only 43% admitted to using ERP for harm-related OCD in their clinical practice. ERP affinity of therapists in theory and practice was related to fewer negative beliefs about ERP, with large effect size (η_p² = 0.367 [CI_95% 0.285 − 0.433]) and lower experiential avoidance with small effect size (η_p² = 0.024 [CI_95% 0.001 − 0.059]) in the total sample.

We found evidence of a theory-practice gap in the treatment of harm-related OCD in a sample of trainee and qualified therapists. To ensure that patients with harm-related OCD content receive the evidence-based treatment they need, negative beliefs about ERP may represent a potential target.

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对与伤害相关的强迫症患者进行反应预防暴露：理论与实践的差距及其与受训者和合格治疗师样本中的经验回避和对暴露的负面信念的关系

尽管反应预防暴露疗法（ERP）疗效显著，但在强迫症（OCD）患者中却使用不足。由于ERP的使用不足可能尤其适用于与伤害相关的强迫症，因此我们以受训和合格的治疗师为样本，调查了理论与实践之间的差距，以及消极信念和经验回避作为ERP在该群体中使用不足的潜在原因。在所有样本中，74% 的治疗师（n = 251）以 CBT 为导向，61% 的治疗师（n = 209）正在接受培训。我们使用治疗师暴露信念量表（TBES）和接受与行动问卷-II（AAQ-II）评估了治疗师的消极信念和经验回避。虽然74%的治疗师推荐ERP用于案例，但只有43%的治疗师承认在其临床实践中使用ERP治疗伤害相关强迫症。治疗师在理论和实践中对ERP的亲和力与对ERP较少的负面信念有关，其效应大小较大（ηp2 = 0.367 [CI95% 0.285 - 0.433]），而在全部样本中，经验回避较低，其效应大小较小（ηp2 = 0.024 [CI95% 0.001 - 0.059]）。为了确保与伤害相关的强迫症患者得到他们所需的循证治疗，对ERP的负面信念可能是一个潜在的目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obsessive-Compulsive and Related Disorders PSYCHIATRY-

CiteScore

4.00

自引率

5.60%

发文量

审稿时长

47 days

期刊介绍： Journal of Obsessive-Compulsive and Related Disorders (JOCRD) is an international journal that publishes high quality research and clinically-oriented articles dealing with all aspects of obsessive-compulsive disorder (OCD) and related conditions (OC spectrum disorders; e.g., trichotillomania, hoarding, body dysmorphic disorder). The journal invites studies of clinical and non-clinical (i.e., student) samples of all age groups from the fields of psychiatry, psychology, neuroscience, and other medical and health sciences. The journal''s broad focus encompasses classification, assessment, psychological and psychiatric treatment, prevention, psychopathology, neurobiology and genetics. Clinical reports (descriptions of innovative treatment methods) and book reviews on all aspects of OCD-related disorders will be considered, as will theoretical and review articles that make valuable contributions. Suitable topics for manuscripts include: -The boundaries of OCD and relationships with OC spectrum disorders -Validation of assessments of obsessive-compulsive and related phenomena -OCD symptoms in diverse social and cultural contexts -Studies of neurobiological and genetic factors in OCD and related conditions -Experimental and descriptive psychopathology and epidemiological studies -Studies on relationships among cognitive and behavioral variables in OCD and related disorders -Interpersonal aspects of OCD and related disorders -Evaluation of psychological and psychiatric treatment and prevention programs, and predictors of outcome.