Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder

Area of Science:

• Psychiatry
• Clinical Psychology
• Behavioral Therapy

Background:

• Exposure and response prevention (EX/RP) is effective for obsessive-compulsive disorder (OCD).
• Patient adherence to EX/RP is often suboptimal.
• Motivational interviewing (MI) enhances treatment adherence in other conditions.

Purpose of the Study:

• To assess if adding MI to EX/RP improves patient adherence to EX/RP procedures in adults with OCD.
• To evaluate the impact of EX/RP+MI on OCD and depressive symptoms, readiness for change, and quality of life.

Main Methods:

• Pilot study with a randomized controlled design.
• 30 adults with OCD were randomized to 18 sessions of EX/RP or EX/RP+MI.
• Therapist-rated adherence, independent evaluator assessments, and patient self-report measures were used.

Main Results:

• Both EX/RP and EX/RP+MI groups showed significant improvement in OCD symptoms.
• No significant difference in patient adherence to between-session EX/RP procedures was found between the two groups.
• Treatment conditions varied in MI congruence but not in EX/RP procedure conduct.

Conclusions:

• Adding MI to EX/RP did not enhance patient adherence in this sample of adults with OCD.
• Alternative MI delivery methods and targeting less-ready patients may be necessary for future studies.
• Further research is recommended to optimize MI for improving OCD treatment adherence.