Mclean Hospital

Cutting Edge: News from the OCDI Office of Clinical Assessment & Research

April 2, 2013

The OCR is currently working on more than a dozen projects in various stages of completion with many more in the works. Our sincerest thanks go out to the patients, their families, the OCD Institute staff, and the various collaborators who have made research possible at the OCDI this year. We are better able to help others because of your efforts.

Our Mission

The primary mission of the OCR is to advance the science and practice of exposure therapy and its pharmacological complement to improve the lives of current and future patients. The OCD Institute is a rich environment for this kind of work because we have many expert clinicians who also value and participate in research. This means that our research is driven by the complex questions and practical issues faced in the day to day effort to help patients overcome their OCD.

Facing Our Fears

Stock photoJust ask anyone you know if they’d volunteer to face their worst fear on a daily basis…most of us wouldn’t. Therefore, it’s not surprising that a major challenge for patients during treatment is maintaining consistent and meaningful engagement with the process. Though exposure and response prevention (ERP) therapy is the gold standard treatment for OCD, many patients are reluctant to try this form of treatment, and others may stop practicing before getting maximum benefit. When patients use avoidance and/or compulsions during treatment, no new learning can occur during the ERPs and little, if any, progress will be made.

The OCR is currently running a clinical trial to enhance treatment engagement by making the experience of ERP more tolerable/acceptable to patients. This trial is being led by two OCDI therapists (Nate Gruner and Jen Hicks) and pilot data from this project will be presented at McLean Research Day in January 2013.

How Do We Know if ERP is Working?

Once a patient has decided to engage treatment without rituals or avoidance, the fear response naturally subsides over time. This reduction in fear (i.e., habituation) is most commonly measured by asking the patient to rate their distress during the ERP, using a number scale (e.g., 0-10). Therapists rely on these fear ratings to gauge whether or not the ERPs are working. However, researchers around the world have failed to find a consistent relationship between habituation and overall improvement after treatment. Instead, some new and exciting research suggests that fear toleration may be more important than fear reduction for obtaining a long-lasting response to ERP.

The OCDI has been on the cutting edge, clinically, by offering specific therapy groups to improve distress tolerance (i.e., emotion regulation, mindfulness). The OCR has also been investigating measuring patients’ willingness to embrace uncertainty, likelihood to experience distress during ERP, and measuring fear reduction throughout treatment.

Relapse Prevention

Unfortunately, some patients who benefit from ERP will experience relapse at some point after treatment. The OCR is in the process of developing a comprehensive follow-up program, which will reach out to patients, their families, and their treaters to gather information that might help us better understand how relapse occurs and how to prevent it. This is the result of collaboration between the OCR and Diane Davey, Brock Maxwell, and the OCDI social workers (Perrie Merlin, Thea Cawley, Rebecca Snyder, and Ben Eckstein). The OCR is also collaborating with Leslie Shapiro, an expert behavior therapist at the OCDI, who is exploring the role of untreated guilt as a risk factor for relapse. Shapiro’s work has culminated in a specific protocol for addressing guilt during treatment at the OCDI.

New Lab

The OCR has new lab space on the third floor of North Belknap, made possible through creative problem-solving by Jesse Crosby and collaboration with Dost Öngür and his team. This new space will streamline the process of data collection, lessening the burden on our patients and improving our efficiency in getting clinical data to treatment teams.

Thanks for your interest and support of the initiatives discussed above and all the others we didn’t have room for in this issue. Best wishes for 2013!