Willingness to experience unpleasant thoughts, emotions, and bodily sensations at admission does not predict treatment outcome in inpatients with obsessive–compulsive disorder

Abstract

Abstract Background Some persons with obsessive–compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet. Methods We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions. Results Obsessive–compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables. Conclusions Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive–compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.

Keywords

• Obsessive–compulsive disorder
• Psychotherapy
• Exposure and response prevention
• Inpatient treatment
• Willingness