(PS7-17) Leveraging Patient and Clinician Ratings of OCD Insight to Evaluate the Validity of Ecological Momentary Assessment

Abstract Text: Ecological momentary assessment (EMA; Shiffman & Stone, 2011) is a method of repeatedly collecting data in a participant’s natural environment over time. To date, studies of EMA in OCD have been used to measure treatment efficacy, as well as highlight the potential for traditional questionnaires to underestimate OCD severity and leave gaps in symptom profiles (Jaeger et al. 2024; Tilley & Rees, 2014). However, EMA’s reliability in measuring OCD-related insight (perceived unreasonableness of obsessions/compulsions) remains unexplored. The clinician-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al., 1989), the gold standard for OCD symptoms, includes an insight assessment, which has significant clinical implications on symptom profile and treatment efficacy (Cherian et al. 2012). Insight assessments, whether clinician-rated or self-reported, are subjective and influenced by momentary perceptions, emotions, and judgments. Thus, it is important to explore the correlation between clinician-rated insight scores (single time point) and self-report insight scores (averages throughout the day) to validate EMA against interview-based methods.

Patients in a partial/residential treatment program participated in a smartphone-based cognitive bias modification study (N = 52; Mage = 28.46, SDage = 10.30). Most participants identified as White (84.6%), women (59.6%), and heterosexual (57.7%). Following informed consent, a series of measures were completed within the first two weeks of treatment and at the conclusion of the study (Mdays from baseline = 30.47, SD = 6.68), which included the clinician-rated Y-BOCS, in which insight was rated 0-4 (0 = Excellent insight, 1 = Good insight, 2 = Fair insight, 3 = Poor insight, 4 = Lacks insight). EMA data was collected four times daily (8am-10am, 12pm-2pm, 4pm-6pm, and 8pm-9pm), for four weeks, throughout treatment, via MetricWire (Stuart & De Souza, 2013). Response options were 0-100, with a sliding scale from interpreting OCD-related concerns as unreasonable (0 = Excellent insight) to reasonable (100 = Lacks insight). Pearson's correlation coefficients examined relations between clinician-rated and self-reported measures of insight at each time point.

For EMA surveys, the mean insight scores were 31.45 (SD = 21.69) for morning, 31.48 (SD = 21.98) for afternoon, 31.73 (SD = 21.96) for evening, and 31.20 (SD = 22.80) for night. Clinician-rated insight scores averaged 1.11 (SD = 0.84) at baseline and 1.02 (SD = 0.78) at the final study visit. There were medium-sized positive correlations between insight assessed via EMA and clinician-ratings (rs = 0.30-0.40; ps < .05), suggesting a moderate association.

This study is the first to analyze differences in OCD insight comparing EMA-reported and clinician-rated insight levels, finding medium-sized correlations. Limitations include a racially homogenous sample. The observed associations suggest self-reporting insight via EMA may be a valid method of assessing OCD insight throughout treatment.