Behavioral avoidance as a factor in concentrated exposure and response prevention for obsessive-compulsive disorder

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-03-21 DOI:10.1016/j.jocrd.2024.100871

Michael G. Wheaton , Kristen Hagen , Thröstur Björgvinsson , Gerd Kvale , Bjarne Hansen

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Abstract

Although exposure and response prevention (ERP) is recommended for adults with obsessive-compulsive disorder (OCD), some recipients do not fully respond while others improve and subsequently relapse. Identifying factors associated with poor outcomes is therefore highly important. We investigated behavioral avoidance as one potential factor. Data came from a large randomized controlled trial that delivered a concentrated ERP protocol over the course of four consecutive days in accord with the Bergen 4-Day Treatment (B4DT). Avoidance was assessed with the auxiliary item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Although behavioral avoidance did not predict acute outcome at immediate post-treatment, patients with substantial avoidance behaviors prior to treatment had worse long term (12-month) outcomes (increased OCD severity and greater functional impairment), after controlling for OCD severity at baseline. Avoidance significantly decreased from pre-to post-treatment but increased from post-treatment to 3-month and 12-month follow-up. Change in avoidance from post-treatment to 3-month follow-up predicted subsequent OCD worsening at 12-months, after controlling for change in global OCD severity. Results suggest that avoidant patients can benefit from concentrated ERP but may be at increased risk of poorer long-term outcomes. Future work should investigate strategies to identify and ameliorate worsening avoidance to reduce relapse.

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行为回避是强迫症集中暴露和反应预防的一个因素

虽然暴露与反应预防疗法（ERP）被推荐用于强迫症（OCD）成人患者，但有些受试者并不能完全应答，而有些受试者的情况有所改善，但随后又复发了。因此，找出与不良结果相关的因素非常重要。我们研究了行为回避这一潜在因素。数据来自于一项大型随机对照试验，该试验根据卑尔根四日治疗法（B4DT），在连续四天的时间里实施集中的 ERP 方案。回避行为通过耶鲁-布朗强迫症量表（YBOCS）的辅助项目进行评估。虽然行为回避并不能预测治疗后即刻的急性结果，但在控制了基线时的强迫症严重程度后，治疗前有大量回避行为的患者的长期（12 个月）结果更差（强迫症严重程度增加，功能受损更严重）。从治疗前到治疗后，回避行为明显减少，但从治疗后到 3 个月和 12 个月的随访，回避行为则有所增加。在控制了整体强迫症严重程度的变化后，从治疗后到3个月随访期间回避的变化预示着12个月后强迫症的恶化。研究结果表明，回避型患者可以从集中的ERP治疗中获益，但长期疗效较差的风险可能会增加。未来的工作应研究识别和改善恶化的回避策略，以减少复发。

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

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.