(PS7-9) Comparing a Novel Cognitive-behavioral Intervention to Supportive Psychotherapy on Obsessive-compulsive Disorder Symptoms in a Randomized Controlled Trial

Abstract Text: Repetitive negative thinking is a core dysfunction of obsessive-compulsive disorder (OCD; Wahl et al., 2019). Emotion regulation therapy (ERT) is a novel modular intervention that combines cognitive behavioral therapy with affect science to improve regulatory abilities and modify the functionality of repetitive thinking (Mennin et al., 2018). One of ERT’s modules is the Attention Regulation module which teaches mindfulness skills. This analysis aims to compare an Attention Regulation only version of ERT (“attention regulation therapy” or “ART”) versus supportive psychotherapy (SPT) on the impact of OCD symptom severity to determine whether this novel treatment could be effective for individuals with OCD experiencing repetitive thinking.
Participants were randomized to 8-weeks of ART or SPT. Pre-, mid-, post-treatment, and at 3-month follow-up (3MFU) participants were given the Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al., 1989). A linear mixed model (LMM) tested effects of time point, treatment group, and their interactions on Y-BOCS total, Y-BOCS obsessions, and Y-BOCS compulsions.
Participants (ART, n=16; SPT, n=19) were on average 30 years old, 57% Women, 77% non-Hispanic, and 63% White. The three LMMs revealed significant effects of time, but no group effects or group x time interactions. Given we were underpowered to detect interactions, we used Tukey’s pairwise comparisons of the LMM to examine time effects for each treatment group separately. First, Y-BOCS total scores were significantly reduced in both groups from pre- to post-treatment (ART: estimated marginal mean [EMM] difference=7.9, SE=1.9, p< 0.001; SPT: EMM difference=5.2, SE=1.7, p=0.02); but at 3MFU, ART remained significantly lower than baseline (EMM difference=7.1, SE=2.0, p=.003) while SPT only trended towards difference (EMM difference=4.1, SE=1.7, p=.09). Second, Y-BOCS obsessions were significantly reduced in both groups from pre- to post-treatment (ART: EMM difference=3.6, SE=1.0, p=0.003; SPT: EMM difference=3.0, SE=0.9, p=0.005); but at 3MFU, only ART remained significantly lower than baseline (EMM difference=3.5, SE=1.1, p=0.006) while SPT was no longer significantly different (EMM difference=1.9, SE=0.9, p=0.17). Finally, Y-BOCS compulsions were significantly reduced for ART from pre- to post-treatment (EMM difference=4.3, SE=1.2, p=0.002) and 3MFU (EMM difference=3.6, SE=1.3, p=0.02); but for SPT there were no significant differences from pre- to post-treatment (EMM difference=2.2, SE=1.1, p=0.18) or 3MFU (EMM difference=2.3, SE=1.1, p=0.16).
ART, a novel cognitive-behavioral intervention focused on decreasing repetitive negative thinking, significantly reduced OCD symptoms from pre- to post- treatment and may outperform SPT in targeting compulsions as well as maintaining decreased OCD symptoms at 3MFU, though research in fully powered samples is needed. While many treatments are effective for OCD, a significant proportion of people do not benefit and may need an alternative treatment (Knopp et al., 2013). By demonstrating that a novel intervention, such as ART, is effective in reducing symptoms of OCD, we can provide individuals with more options that can be tailored to their needs