(PS7-16) Incompleteness and Harm Avoidance: Associations with Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder

Abstract Text: Obsessive-compulsive disorder (OCD) is a heterogenous disorder, posing difficulties for conceptualization and treatment. A better understanding of the motivational dimensions that maintain OCD symptoms, namely harm avoidance (HA) and feelings of incompleteness (INC), may lead to further refinement of treatment strategies. Indeed, exposure and response prevention (ERP) for OCD was originally developed to primarily address HA, with less focus on INC. Some research suggests that individuals with OCD who endorse greater INC may have worse treatment outcomes compared to those with greater HA. However, few studies have examined the specific relationships between these dimensions and OCD symptom severity over the course of treatment. In addition, associations between HA and INC and symptoms of other conditions commonly comorbid with OCD, such as anxiety and depression, are not well explored. In a naturalistic sample of adults seeking treatment for OCD (N = 22, 59.1% female, 18.2% racial or ethnic minority) at an outpatient clinic specializing in anxiety and related disorders, individuals completed measures of anxiety and depression using the Depression Anxiety Stress Scales (DASS), obsessive-compulsive symptoms using the Yale-Brown Obsessive Compulsive Scale Self-Report Version (Y-BOCS), and HA and INC using the Obsessive-Compulsive Core Dimensions Questionnaire (OCCDQ) prior to engaging in a course of individual CBT. Data collection is ongoing as these individuals progress through treatment, and measures will be re-administered after patients complete 15 sessions of treatment. Both the INC (r = .51, p = .015) and HA (r = .53, p = .012) subscales were significantly associated with Y-BOCS severity scores. The INC subscale was also significantly associated with the DASS Anxiety subscale (r = .43, p = .044), while the HA subscale was not (r = .30, p = .183). Moreover, the HA subscale was significantly associated with the DASS Depression subscale (r = .47, p = .029), while the INC subscale was not (r = .21, p = .343). However, the strength of the correlations between the INC and HA subscales and the DASS subscales were not significantly different from one another when directly compared. We plan to conduct longitudinal analyses using follow-up data to examine whether there are significant differences in treatment outcome (changes in Y-BOCS and DASS subscales over 15 sessions) associated with baseline INC and HA, as well as changes in INC and HA throughout treatment. At baseline, INC and HA dimensions are both related to obsessive-compulsive symptom severity. This finding differs from that of a previous study in an OCD clinical sample, which found that only INC, and not HA, was significantly associated with Y-BOCS severity scores. The present study also aims to determine whether baseline INC and HA or changes in INC and HA after 15 sessions of individual CBT are associated with treatment outcome. A better understanding of how INC and HA dimensions impact treatment outcome will help to refine treatment approach and conceptualization for INC in OCD. Limitations include a small sample size at present and data from a single time point but will be addressed by continued data collection to increase sample size and planned longitudinal analyses.