A thematic analysis of barriers and facilitators to participant engagement in group exposure and response prevention therapy for obsessive–compulsive disorder

Tamara Leeuwerik, Giorgia Caradonna, Kate Cavanagh, Elizabeth Forrester, Anna‐Marie Jones, Laura Lea, Claire Rosten, Clara Strauss

Research output: Contribution to journalArticlepeer-review


Exposure and response prevention (ERP) is the gold standard in the treatment of the obsessive–compulsive disorder (OCD). It can be delivered effectively using an individual or group therapy format. Nonetheless, a sizeable proportion of people diagnosed with OCD do not experience OCD symptom remission following ERP. Research suggests that participant engagement with ERP tasks predicts therapy outcomes but there is little consistent evidence across studies on what predicts engagement. A recent meta-analysis of participant engagement in cognitive-behavioral therapy for OCD found that group ERP had a comparatively lower dropout rate than individual ERP. Little is known about participant perceptions of ERP to guide an understanding of how the group therapy format may affect participant engagement. This study conducted a qualitative exploration of what helps or hinders participants' engagement in group ERP. It involved thematic analysis of semi-structured interview data collected at a 6-month follow-up from 15 adults with OCD who took part in group ERP. The study identified five main themes that captured participants' perceived facilitators and barriers to engagement in therapy: ‘Group processes’, ‘Understanding how to overcome OCD’, ‘Personal relevance’, ‘Personal circumstances’, and ‘Attitudes towards ERP’, which captured dynamically inter-related barriers and facilitators at the level of the client, therapist, therapy and social environment. Each theme and associated sub-themes are discussed in turn, followed by a consideration of the study's limitations and implications.
Original languageEnglish
Pages (from-to)129-147
Number of pages19
JournalPsychology and Psychotherapy: Theory, Research and Practice
Issue number1
Publication statusPublished - 27 Oct 2022

Bibliographical note

Funding Information:
This research was jointly funded by the Economic and Social Research Council and Sussex Partnership NHS Foundation Trust, through a collaborative studentship provided to the first author (grant number ES/J500173/1). This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB‐PG‐0712‐28083). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.


  • mental health
  • obsessive compulsive disorder
  • behavioural therapy
  • thematic analysis
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology
  • Psychiatry and Mental health
  • Clinical Psychology
  • engagement
  • obsessive–compulsive disorder
  • exposure and response prevention
  • barriers
  • facilitators


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