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Serious negative consequences associated with exposure and response prevention for obsessive-compulsive disorder: A survey of therapist attitudes and experiences.

Authors
  • Schneider, Sophie C1
  • Knott, Lindsey1
  • Cepeda, Sandra L1
  • Hana, Lynn M1
  • McIngvale, Elizabeth2
  • Goodman, Wayne K1
  • Storch, Eric A1
  • 1 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
  • 2 The Houston OCD Program, Houston, Texas.
Type
Published Article
Journal
Depression and anxiety
Publication Date
May 01, 2020
Volume
37
Issue
5
Pages
418–428
Identifiers
DOI: 10.1002/da.23000
PMID: 32048376
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Many therapists are reluctant to conduct exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Negative beliefs about the safety and tolerability of ERP are common, especially for harm-related OCD symptoms. The study examined the nature and frequency of ERP-related serious negative consequences (SNC) and therapist attitudes and experiences providing ERP for harm-related OCD. An anonymous survey was completed by 277 therapists with experience treating OCD using ERP. Questions assessed clinical experiences of harm-related exposures, the nature of SNC, and concerns and clinical considerations regarding ERP. Therapist's willingness to treat harm-related OCD was high. SNCs were reported for 6 clients (per-client risk: adults 0.05%, youth 0.01%) and 13 therapists (per therapist risk 4.73%, therapist per-year risk 0.004%). Qualitative analysis identified themes relating to the conduct of treatment, specific exposure types, professional issues, and negative perceptions of ERP. SNC associated with ERP for OCD are rare and primarily represent unintended secondary consequences of OCD or misunderstandings regarding the process and rationale behind ERP. Improving access to ERP will require good communication with clients, families, and other professionals regarding the rationale and safety of ERP. © 2020 Wiley Periodicals, Inc.

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