3 - (SYM 54) Feasibility and Acceptability of an Adjunctive Smartphone-based Cognitive Bias Intervention During Intensive/residential OCD Treatment: A Randomized Controlled Trial

Although Exposure and Response Prevention (ERP) is the gold standard treatment for OCD, non-response is a critical issue. Novel augmentations are needed to target the cognitive vulnerabilities maintaining OCD more efficiently. One potential target for adjunctive interventions is interpretation bias, the tendency to misinterpret intrusive thoughts as dangerous, bad, or predicting harm (Rachman, 1997), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism (e.g., Beard & Amir, 2008). However, studies of CBM-I in OCD have been largely in analogue samples (e.g., Clerkin & Teachman, 2011; Grisham et al., 2014) and clinical samples have been limited to adolescents (Salemink et al., 2015), adults in a 1-week intervention (Amir et al., 2015), and a small trial in intensive/residential treatment (IRT; Falkenstein et al., 2022). 

We evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention to IRT for OCD, hypothesizing it would meet a priori benchmarks for feasibility, acceptability, and adherence. We recruited adults with primary OCD from an IRT program to be randomized to 8 smartphone-based sessions of CBM-I (n = 41) or psychoeducation (n = 34). The majority identified as women (58%), non-Hispanic White (80%), heterosexual (64%), Mage = 30.45 (SD = 11.72), MY-BOCS = 26.35 (‘moderate-severe’ Storch et al., 2015; SD = 4.25). Post-training, the Client Satisfaction Questionnaire-8 (Larsen et al., 1979) measured acceptability. 

For the feasibility of implementation, we had set an a priori benchmark of >50% eligible patients consenting to participate, which was met, with 51.85% consenting. Our a priori benchmark for adherence (>75% completing the 8 sessions) was also met, with 77.0% completing all 8 (86.5% completed >4 of 8 sessions). For acceptability, >75% needed to rate CSQ-8 item #7 (“In an overall, general sense, how satisfied are you with the service you received?”) with >3 (“Mostly” or “Very Satisfied”). This was not met as only 65.7% in the CBM condition endorsed >3; for comparison, 79.3% endorsed >3 for psychoeducation. Results suggest CBM-I is a feasible augmentation to IRT for OCD with strong adherence rates, yet its acceptability needs further study. Future work will examine qualitative feedback provided in exit interviews to better understand and improve upon acceptability. At the trial’s conclusion, we will also examine target engagement and clinical outcomes. Our ultimate goal is to contribute to the development of scalable augmentations to ERP.