Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

Clara Strauss, Laura Lea, Mark Hayward, Elizabeth Forrester, Tamara Leeuwerik, Anna-Marie Jones, Claire Rosten

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP − the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.
Original languageEnglish
Pages (from-to)39-47
JournalJournal of Anxiety Disorders
Volume57
DOIs
Publication statusPublished - 30 Apr 2018

Fingerprint

Mindfulness
Obsessive-Compulsive Disorder
Randomized Controlled Trials
Implosive Therapy
Diagnostic and Statistical Manual of Mental Disorders
Guidelines
Confidence Intervals
Depression
Research

Bibliographical note

Under a Creative Commons Attribution 4.0 International (CC BY 4.0)

Keywords

  • OCD
  • mindfulness
  • ERP
  • exposure and response prevention
  • cognitive therapy
  • MBCT

Cite this

Strauss, Clara ; Lea, Laura ; Hayward, Mark ; Forrester, Elizabeth ; Leeuwerik, Tamara ; Jones, Anna-Marie ; Rosten, Claire. / Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial. In: Journal of Anxiety Disorders. 2018 ; Vol. 57. pp. 39-47.
@article{6b51ab850c604a26824b66143070aeac,
title = "Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial",
abstract = "Background Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP − the minimum clinically important difference was not contained in the 95{\%} confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.",
keywords = "OCD, mindfulness, ERP, exposure and response prevention, cognitive therapy, MBCT",
author = "Clara Strauss and Laura Lea and Mark Hayward and Elizabeth Forrester and Tamara Leeuwerik and Anna-Marie Jones and Claire Rosten",
note = "Under a Creative Commons Attribution 4.0 International (CC BY 4.0)",
year = "2018",
month = "4",
day = "30",
doi = "10.1016/j.janxdis.2018.04.007",
language = "English",
volume = "57",
pages = "39--47",
journal = "Journal of Anxiety Disorders",
issn = "0887-6185",

}

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial. / Strauss, Clara; Lea, Laura; Hayward, Mark; Forrester, Elizabeth; Leeuwerik, Tamara; Jones, Anna-Marie; Rosten, Claire.

In: Journal of Anxiety Disorders, Vol. 57, 30.04.2018, p. 39-47.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

AU - Strauss, Clara

AU - Lea, Laura

AU - Hayward, Mark

AU - Forrester, Elizabeth

AU - Leeuwerik, Tamara

AU - Jones, Anna-Marie

AU - Rosten, Claire

N1 - Under a Creative Commons Attribution 4.0 International (CC BY 4.0)

PY - 2018/4/30

Y1 - 2018/4/30

N2 - Background Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP − the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

AB - Background Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. Methods This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. Results Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP − the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. Conclusions MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

KW - OCD

KW - mindfulness

KW - ERP

KW - exposure and response prevention

KW - cognitive therapy

KW - MBCT

U2 - 10.1016/j.janxdis.2018.04.007

DO - 10.1016/j.janxdis.2018.04.007

M3 - Article

VL - 57

SP - 39

EP - 47

JO - Journal of Anxiety Disorders

JF - Journal of Anxiety Disorders

SN - 0887-6185

ER -