Treating disgust in obsessive-compulsive disorder: Clinician perspectives in a survey study

Abstract

Exposure plus response prevention (ERP) emphasizes fear-reduction strategies, yet many patients have OCD symptoms driven by emotions other than fear—particularly disgust. Although disgust OCD appears to be associated with worse treatment outcomes, ERP might be modified to enhance fit with disgust-based pathology. It remains unknown how clinicians modify ERP for this presentation in practice and to what effect. In this study, 90 mental health clinicians from diverse professional backgrounds completed an online survey assessing their experiences and perceptions applying ERP with disgust OCD. Participants generally viewed ERP to be effective for disgust OCD. Of 25 tailoring strategies surveyed (derived from the empirical literature and authors’ own clinical experiences), most strategies were used commonly and rated as at least “fairly helpful” for both adults and youth. Among the most frequently used ERP modifications were informal functional assessment, emphasizing tolerating discomfort, designing exposures that elicit disgust, and additional acceptance and mindfulness techniques. Neither ERP nor disgust OCD expertise was related to the total number of tailoring strategies endorsed, the endorsement of any given strategy, or the perceived effectiveness of ERP for disgust; however, expertise was related to the perceived helpfulness of 12 tailoring strategies. In addition, 8 novel ERP tailoring strategies were identified from open-ended response items. Results support the view that ERP can be tailored to treat disgust symptoms and highlight the relevance of evaluative conditioning, inhibitory learning, and cognitive-behavioral interventions traditionally less emphasized in ERP. Findings will inform the development of the first comprehensive protocol for disgust OCD. 249/250 words.