10/17/2024
"While ERP is the well-known, “gold-standard” of OCD treatment for adults and youth (Geller & March 2012), remission rates range from 49 to 53% in youth (Öst, Riise, Wergeland, Hansen, & Kvale, 2016). This high rate of remission may suggest a need for further exploration of treatment options in order to enhance response rates to evidence-based treatment for OCD. In the past two decades, there has been a rise in “third-wave” approaches for the treatment of anxiety and OCD, particularly acceptance and commitment therapy (ACT), as seen in the important review by Bluett, Homan, Morrison, Levin, and Twohig (2014). More specifically, there is growing support for ACT and ACT-enhanced ERP (Bluett et al., 2014; Twohig et al., 2018) as feasible and effective alternative treatments for OCD in adults and adolescents (Armstrong, Morrison, & Twohig, 2013; Shabani et al., 2019).
In the treatment of OCD, ACT seeks to enhance psychological flexibility by creating new relationships with obsessive thoughts and anxious feelings. The purpose of changing one's relationship with internal experiences is to increase engagement in meaningful activities, rather than trying to decrease the obsession or avoid anxiety. Psychological inflexibility has been repeatedly shown to predict OCD symptoms and mediate OCD treatment outcomes (Ong et al., 2020); ACT is supported in targeting psychological inflexibility and decreasing OCD symptoms and functional impairment (Twohig, Vilardaga, Levin, & Hayes, 2015). Enhancing psychological flexibility also theoretically aids with elements of ERP such as response prevention and exposure engagement (Twohig, Abramowitz, et al., 2015, b), further emphasizing the utility of that ACT can bring to the treatment of OCD. Finally, ACT processes such as acceptance of obsessions are predictive of positive outcomes in traditional ERP in an intensive setting (Reid et al., 2017).
This study presents a promising case series for an intensive program utilizing an ACT+ERP framework for the treatment of adolescent OCD. All participants ended treatment in the mild to moderate range of OCD severity with 32–60% reductions on their CY-BOCS scores from pre-to post-treatment. As previously noted, clients are considered treatment responders if they experience greater than or equal to 25% reduction on CY-BOCS scores and they are considered recovered if they experience 45–50% or greater reduction on their CY-BOCS or a score less than or equal to 14 (Storch et al., 2010). Thus, participants were aggregately and individually considered responsive to treatment, with P3 achieving full remission and P2 almost achieving full remission. All participants also experienced reliable change in CY-BOCS scores. In terms of psychological inflexibility, participants ended with an average of nine on the AFQ-Y. This score represents a reduction of 76% compared to the start of treatment. Lastly, all participants ended treatment in the normal range of depression, anxiety, and stress according to the DASS-21. All participants were also considered recovered based previously established criteria for the DASS-21 (22–33% changes in symptoms; Ronk et al., 2013)."
