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Symposia

Child / Adolescent - Anxiety

Using Research Findings to Extend Treatment’s Effectiveness and Reach: Examples from Pediatric Anxiety & OCD

4 - (SYM 33) Clinician Perspectives on Using Exposure to Treat Non-fear-based Presentations of Obsessive-compulsive Disorder

Saturday, November 22, 2025
11:09 AM - 11:30 AM CST
Location: Strand 9, Level 2
Keywords: Anxiety, OCD (Obsessive Compulsive Disorder), CBT
Recommended Readings: Franklin, M. E., Engelmann, J. M., Bulkes, N. Z., Horvath, G., Piacsek, K., Osterlund, E., Freeman, J. B., Schwartz, R., Himle, M., & Riemann, B. C. (2024). Intensive CBT telehealth for pediatric OCD during the COVID-19 pandemic: Comparison with a matched sample treated in person. Journal of the American Academy of Child & Adolescent Psychiatry Open, 2(1), 26-35.,   Freitag, G. F., Salem, H., Conroy, K., Busto, C., Adrian, M., Borba, C. P. C., . . . Comer, J. S. (2023). The patient-reported outcomes measurement information system (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the kids FACE FEARS sample. Journal of Anxiety Disorders, 94, 1-9. doi:https://doi.org/10.1016/j.janxdis.2023.102677,   Kemp, J., Barker, D., Benito, K., Herren, J., & Freeman, J. (2021). Moderators of psychosocial treatment for pediatric obsessive-compulsive disorder: Summary and recommendations for future directions. Journal of Clinical Child and Adolescent Psychology, 50(4), 478-485. doi:https://doi.org/10.1080/15374416.2020.1790378,   Schwartz, R. A. (2018). Treating incompleteness in obsessive-compulsive disorder: A meta-analytic review. Journal of Obsessive-Compulsive and Related Disorders, 19, 50-60. doi:https://doi.org/10.1016/j.jocrd.2018.08.001,  
Abstract Body

Exposure plus response prevention (ERP) emphasizes fear-reduction strategies, yet many patients have OCD symptoms driven by emotions other than fear. Two prominent forms of Non-Fear-Based (NFB) OCD are: 1) Not Just Right (NJR), when compulsions are performed to achieve inner completeness, and 2) Disgust OCD, in which rituals are done to eliminate feelings of disgust or revulsion. While these presentations respond poorly to standard treatment, ERP might be modified to enhance fit and effectiveness. However, it remains unknown how clinicians tailor ERP to NFB symptoms in practice and to what effect.

Mental health clinicians (N = 97) from diverse backgrounds completed a brief online survey assessing their experiences and perceptions applying ERP with NFB OCD. The survey included a list of 22 (for NJR) and 25 (for disgust) tailoring strategies derived from the empirical literature and authors’ clinical experiences, and asked clinicians to specify which they had used; when a strategy was endorsed, participants rated its helpfulness from 1/Not helpful at all to 4/Very helpful for adults and youth separately. The survey also included open-ended response items assessing other tailoring strategies not mentioned.

Clinicians generally viewed ERP to be somewhat-to-very effective for both NFB presentations. Most strategies surveyed were used commonly and rated as at least “fairly helpful” for both adults and youth. Strategies consistent with inhibitory learning, acceptance and commitment therapy, evaluative conditioning, and cognitive-behavioral interventions traditionally less emphasized in ERP emerged as particularly relevant. Expertise in ERP and NFB OCD was not related to the total number of tailoring strategies endorsed, the endorsement of any given strategy, or ERP’s perceived effectiveness; however, expertise was related to the perceived helpfulness of several strategies. In addition, 13 and 8 novel tailoring strategies for NJR and disgust, respectively, were identified from open-ended response items. Results support the view that ERP can be tailored to treat NFB OCD and inform the development of the first protocol for these difficult-to-treat presentations.