Avoidance Predicts Worse Long-term Outcomes From Intensive OCD Treatment
Relapse Prevention
“The fact that they did equally well in the short run I think was great,” Dr. Wheaton said.
Previous research, including 2018 and 2023 papers from Wheaton’s team, has shown that more avoidant patients have worse outcomes from standard 12-week ERP programs.
One possible explanation for this difference is that in the Bergen treatment, most exposures happen during face-to-face time with a therapist instead of as homework, which may be easier to avoid, he said.
,“But then the finding was that their symptoms were worsening over time — their avoidance was sliding back into old habits,” said Dr. Wheaton.
He would like to see the study replicated in diverse populations outside Norway and in treatment-naive people. Dr. Wheaton also noted that the study assessed avoidance with only a single item.
Future work is needed to test ways to improve relapse prevention. For example, clinicians may be able to monitor for avoidance behaviors post-treatment, which could be the start of a relapse, said Dr. Wheaton.
Although clinicians consider avoidance when treating phobias, social anxiety disorder, and panic disorder, “somehow avoidance got relegated to item 11 on the YBOCS that isn’t scored,” Helen Blair Simpson, MD, PhD, director of the Center for OCD and Related Disorders at Columbia University, New York, New York, said during the presentation.
A direct implication of Dr. Wheaton’s findings to clinical practice is to “talk to people about their avoidance right up front,” said Dr. Simpson, who was not part of the study.
Clinicians who deliver ERP in their practices “can apply this tomorrow,” Dr. Simpson added.
Dr. Wheaton reported no disclosures. Dr. Simpson reported a stipend from the American Medical Association for serving as associate editor of JAMA Psychiatry and royalties from UpToDate, Inc for articles on OCD and from Cambridge University Press for editing a book on anxiety disorders.
A version of this article appeared on Medscape.com.
