7 - (IOP 16) A Pilot Trial of Digital Approach-avoidance Training as an Augmentation to Partial/residential Treatment for Contamination OCD

Exposure and Response Prevention (ERP), the first line of treatment for OCD, leaves 40-50% of patients unrecovered. Novel augmentations are needed that more efficiently target the mechanisms that play a fundamental role in the development and maintenance of OCD, such as avoidance. Approach/Avoidance Training (AAT) is a type of cognitive bias modification intended to strengthen automatic approach toward feared stimuli. AAT has been administered in various populations to study automatic action tendencies, which is an individual's propensity towards approaching or avoiding threatening stimuli, however AAT has not yet been tested with adults with OCD. This study aimed to evaluate the feasibility and acceptability of AAT in a sample of adults seeking treatment in a partial/residential hospital program for OCD.

Adults (N = 21) with contamination OCD (measured by the Dimensional Obsessive-Compulsive Scale (DOCS; Abramowitz et al., 2010) contamination subscale (M = 11.64, SD = 4.19)) were recruited for participation, identified primarily as female (n = 11, 52%), non-Hispanic White (n = 18, 86%), heterosexual (n = 13, 67%), and had a mean age of 32.72 (SD = 13.30). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989) was used to assess OCD symptom severity at pre and post training. Participants were asked to rate a series of images to personalize contamination-related and neutral stimuli for the task. They then completed computerized AAT training sessions twice a week for four weeks. During these sessions, participants used a joystick to simulate pulling or pushing images of contaminated objects toward or away from themselves. Participants were instructed to push or pull the images based on their orientation. A priori benchmarks were set for feasibility (≥ 75% of participants completing 6 of the 8 sessions) and acceptability on a post-training exit interview (M ≥ 4.5) Items on the post-training exit interview were rated on of 0 (not at all) to 7 (very much) and included the following items: "I felt the program was helpful”, “I enjoyed the task I completed”, The program included content and/or situations that were relevant to me", and “The program was user-friendly”.

The benchmark for feasibility was met as 75% of participants completed at least 6 of the 8 sessions. The benchmark for acceptability was also met (M = 4.52, SD = 1.65). In the qualitative interviews, participants had feedback such as, “[The AAT] made me look at triggers I don't normally look at.” Participants also reported that seeing the triggering images helped them when seeing contaminated items in day to day life (e.g. “It made it easier when triggering photos would appear while I was online and using social media”).

Initial results suggest that computerized AAT is both feasible and acceptable to participants to engage in during treatment. These results need to be interpreted with caution due to the low sample size, lack of control group, and limited demographic diversity. Ultimately, if the AAT has promising feasibility and acceptability data in larger and more diverse samples, future research should examine target engagement compared with a control condition, and clinical outcomes of the AAT including testing AAT as an augmentation to traditional ERP treatment for OCD.