Inference-based CBT versus CBT with exposure and response prevention for obsessive-compulsive disorder: The role of pre-treatment anxiety and feared consequences on treatment outcome

Abstract

Objective: Traditional cognitive behavioral therapy (CBT) and inference-based CBT (I-CBT) are both effective interventions for obsessive-compulsive disorder (OCD). However, only about half of the patients seem to benefit sufficiently from these treatments. This study investigated whether pre-treatment anxiety and feared consequences (of not performing compulsions) predict OCD treatment outcome and whether these potential predictors have differential effects between CBT and I-CBT. Method: Data from a previously completed randomized controlled trial were analyzed. A total of 197 patients were randomly assigned to CBT or I-CBT. The primary outcome was OCD symptom severity, assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at posttreatment, 6-month and 12-month follow-up. Predictors included pre-treatment anxiety, using the Beck Anxiety Inventory (BAI), and feared consequences, using the Fixity of Belief Questionnaire (FBQ), both assessed at baseline. Linear mixed models analyses were performed while controlling for Y-BOCS baseline scores. Results: Higher BAI scores and having no feared consequences did not significantly predict higher Y-BOCS scores, nor were the effects moderated by treatment condition. A substantial 40% of participants reported having no feared consequences. Discussion: Pre-treatment anxiety severity and feared consequences did not predict worse treatment outcomes. These findings suggest that highly anxious patients and those without feared consequences of not performing their compulsions could benefit equally from both CBT and I-CBT.