A network analysis of obsessive-compulsive patients in intensive outpatient treatment.

Abstract

Background: The network theory of mental disorders posits that associations between symptoms activate other symptoms to maintain a disorder over time. Network analytic approaches therefore may inform treatment targets. In the present study, we compared baseline OCD symptom networks among treatment responders to non-responders and examined how network structure and connectivity changed from before to after exposure and response prevention (ERP) treatment.

Methods: Community adults with OCD (n = 712) who underwent intensive outpatient treatment were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) at admission and discharge. Network comparison tests were used to (a) examine differences in baseline symptom network structures between treatment responders versus non-responders and (b) examine changes in network structures from pre- to post-treatment.

Results: Pre-treatment network structures and global connectivity did not differ significantly between treatment responders and non-responders. However, post-treatment networks exhibited greater global strength (i.e., stronger associations between OCD symptoms) and significantly different network structure (i.e., different patterns of associations between OCD symptoms) relative to the pre-treatment network.

Conclusions: Findings showed that network structure and connectivity in OCD may be more informative as a marker of therapeutic change than in discriminating treatment responders from nonresponders using baseline symptoms. After ERP treatment, associations between obsessions and compulsions demonstrated significantly greater global network strength and altered network structure, thus underscoring the potential for network approaches to identify mechanisms of change throughout OCD treatment. Future studies incorporating session-by-session data may clarify when and how these network shifts occur over the course of therapy to help identify treatment targets.