A Translational Study of the Mechanisms of Exposure Therapy for Obsessions: Gradual vs. Variable Exposure Intensity
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 40
- Locations
- 1
- Primary Endpoint
- Change from baseline in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at 3-month follow-up (week 14)
Study Overview
Brief Summary
The current study sought to translate laboratory research on learning and memory to better understand the mechanisms and methods for implementing exposure therapy for unwanted obsessional thoughts. Specifically, we compared the processes and the short- and long-term outcomes of: (a) gradual exposure (EXP-G), emphasizing hierarchical exposure completion, versus (b) variable exposure (EXP-V), emphasizing variability in exposure intensity.
Detailed Description
Although preliminary research suggests that learning to tolerate varying levels of fear during exposure enhances outcomes for some anxiety-related problems, no previous study has examined this possibility in the context of unwanted obsessions. Adults with a moderately distressing obsessional thought were randomly assigned to four twice-weekly sessions of either: (a) gradual exposure (EXP-G), emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V), emphasizing variability in exposure intensity.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
Independent evaluators were blind to the exposure condition participants were assigned to.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •At least 18 years old
- •Willing to attend and audiotape all study sessions
- •Fluent in English
- •Presence of one or more obsessional thoughts that cause marked distress
- •If on a psychiatric medication (e.g., SSRI), willing to remain at a fixed dose while participating in the study (and stabilized on medication for 30 days before beginning the intervention).
Exclusion Criteria
- •Previous cognitive behavioral therapy (CBT) for anxiety
- •Current suicidal ideation
- •Current substance use disorder
- •Current mania or psychosis
- •Currently taking an anxiolytic (e.g., Ativan) or stimulant (e.g., Ritalin) medication
- •Heart, respiratory, or neurological condition
- •Current pregnancy
Arms & Interventions
Gradual Exposure Group
The gradual exposure group received the Gradual Exposure (EXP-G) Intervention.
Intervention: Gradual Exposure (EXP-G) (Behavioral)
Variable Exposure Group
The variable exposure group received the Variable Exposure (EXP-V) Intervention.
Intervention: Variable Exposure (EXP-V) (Behavioral)
Outcomes
Primary Outcomes
Change from baseline in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at 3-month follow-up (week 14)
Time Frame: Baseline (week 0) and 3-month follow-up (week 14)
The Y-BOCS is a clinician-administered interview that assesses obsessive compulsive disorder (OCD) symptom severity over the past week. This measure will be used to assess change over the course of the intervention at four time-points throughout the study (over approximately 3.5 months total).
Secondary Outcomes
- Changes from baseline in Dimensional Obsessive-Compulsive Scale-Unacceptable Thoughts (DOCS-UT) at 3-month follow-up (week 14)(Baseline (week 0) and 3-month follow-up (week 14))
- Changes from baseline in Dimensional Obsessive-Compulsive Scale-Unacceptable Thoughts (DOCS-UT) at post-treatment (week 2)(Baseline (week 0) and post-treatment (week 2))
- Change from baseline in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score at post-treatment (week 2)(Baseline (week 0) and post-treatment (week 2))
- Changes from baseline in Behavioral Approach Test (BAT) Mean Subjective Units of Distress (SUDS) at post-treatment (week 2)(Baseline (week 0) and post-treatment (week 2))
- Changes from baseline in Behavioral Approach Test (BAT) Number of Steps Completed at post-treatment (week 2)(Baseline (week 0) and post-treatment (week 2))
- Changes from baseline in Behavioral Approach Test (BAT) Mean Subjective Units of Distress (SUDS) at 3-month follow-up (week 14)(Baseline (week 0) and 3-month follow-up (week 14))
- Changes from baseline in Behavioral Approach Test (BAT) Number of Steps Completed at 3-month follow-up (week 14)(Baseline (week 0) and 3-month follow-up (week 14))
Investigators
Jon Abramowitz, PhD
Professor, Clinical Psychology, Department of Psychology and Neuroscience
University of North Carolina, Chapel Hill