Preferences for Justice-Based Exposure and Response Prevention Among Individuals With Identity-Related...

Justice-based exposure and response prevention (ERP) has been touted as an alternative approach to (mis)uses and "Fear Factor" overcorrection applications of ERP for obsessive-compulsive disorder (OCD) with identity-related themes (i.e., sexual orientation, gender identity, racism, age, disability/diagnostic status, and economic-themed). Justice-based exposure maintains fidelity to the theoretical and evidence-based mechanisms of ERP while avoiding inadvertent stigmatization of marginalized communities. Justice-based ERP also avoids contributing to societal stigma while potentially increasing buy-in among patients. Despite its widespread support across the OCD field, empirical evidence regarding preferences for justice-based ERP is currently lacking. The present study sought to compare perspectives on justice-based and overcorrection ERP approaches to identity-related OCD themes among 450 individuals with current or past identity-related obsessions (85.6% female, M age = 32.0). Participants reviewed idiographic, symptom-specific justice-based and overcorrection ERP hierarchies for each endorsed symptom theme and were asked a series of questions regarding their perspectives on each hierarchy. Participants reported a considerable preference for justice-based exposures over overcorrection exposures for these themes. Specifically, while overcorrection exposures were associated with higher anxiety expectancy, participants were much more likely to report a willingness to engage in justice-based exposures, perceived them to be more relevant and effective, and found them to be less derogatory and offensive than overcorrection exposures. Findings support the notion that (mis)uses and overcorrection exposures for identity-related OCD themes represent a "Fear Factor" approach that prioritizes anxiety increase at the expense of functionality, and that a justice-based approach may be better aligned with participants' values and treatment expectancies.