Can Psychological Flexibility Help Improve Obsessive-Compulsive Disorder Treatment?

What you need to know

• Cognitive behavioral therapy (CBT) with exposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD)
• This study examined whether psychological flexibility plays a role in improving OCD symptoms during CBT treatment
• Higher psychological flexibility was associated with lower OCD symptoms, but did not directly mediate symptom improvement during treatment

Background on OCD treatment

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform. Cognitive behavioral therapy (CBT) with exposure and response prevention is considered one of the most effective treatments for OCD. However, researchers are still trying to understand exactly how and why CBT works to reduce OCD symptoms.

This study focused on examining the potential role of psychological flexibility in CBT treatment for OCD. Psychological flexibility refers to a person’s ability to accept unpleasant thoughts and feelings rather than trying to suppress or avoid them. The researchers hypothesized that increases in psychological flexibility during treatment might lead to decreases in OCD symptoms.

The study approach

The study included 112 adult patients diagnosed with OCD who were receiving inpatient CBT treatment. The researchers measured patients’ OCD symptoms weekly using a standard rating scale called the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). They also measured psychological flexibility each week using three questions they developed about patients’ ability to face worries and accept unpleasant thoughts and feelings.

Using advanced statistical techniques, the researchers analyzed how psychological flexibility and OCD symptoms changed over the course of treatment. They wanted to see if increases in flexibility preceded and predicted decreases in OCD symptoms.

Key findings

Some of the main findings from the study included:

• OCD symptoms decreased significantly over the course of CBT treatment. On average, patients’ Y-BOCS scores decreased by 8.5 points.
• Psychological flexibility increased during treatment.
• Higher average levels of psychological flexibility were associated with lower OCD symptoms.
• However, changes in flexibility within individual patients did not predict subsequent changes in their OCD symptoms from week to week.
• Higher psychological flexibility at the start of treatment predicted lower OCD symptoms at the end of treatment.

What the results mean

The study findings suggest that psychological flexibility may play a beneficial role in CBT treatment for OCD, but not in the direct way the researchers initially hypothesized. Patients who had higher overall levels of flexibility tended to have less severe OCD symptoms. And those who started treatment with more flexibility ended up with lower symptoms.

However, the study did not find evidence that increases in flexibility directly caused decreases in OCD symptoms from week to week during treatment. This means psychological flexibility may not be a key mechanism or mediator of symptom change in CBT for OCD.

Implications for treatment

While psychological flexibility appears beneficial, the results suggest it may not need to be a primary target of CBT interventions for OCD. The exposure and cognitive techniques used in standard CBT may work through other mechanisms to reduce symptoms.

However, the findings do indicate that patients with higher psychological flexibility tend to do better in treatment overall. Clinicians may want to assess flexibility early on, as those with lower flexibility may need additional support or tailored interventions. Building general coping skills and flexibility could potentially help prepare patients to benefit more from CBT techniques.

Limitations and future research

The researchers note some limitations of the study, including:

• The brief measure of psychological flexibility they developed, which may not have fully captured the concept
• Lack of a control group to compare against CBT treatment
• Focus only on self-reported symptoms

They suggest future studies use more comprehensive flexibility measures and examine other potential mechanisms of change in CBT for OCD. Research incorporating behavioral assessments and long-term follow-up could also provide valuable insights.

Conclusions

• CBT remains an effective treatment for reducing OCD symptoms
• Psychological flexibility is associated with lower OCD symptoms but may not directly mediate symptom changes during CBT
• Assessing flexibility early in treatment may help identify patients who need additional support
• More research is needed on the mechanisms of change in CBT for OCD to further improve treatments

While this study did not find psychological flexibility to be a key mediator of symptom change, it provides valuable data on the relationship between flexibility and OCD symptoms. The findings can help guide future research and clinical practice to optimize CBT and other treatments for OCD.