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Inhibitory Learning-based Exposure Response Prevention Therapy in Obsessive-compulsive Disorder: A Development and

Mareena Thampy¹, Paulomi M Sudhir¹, Ajay Kumar¹

¹Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.

Indian Journal of Psychological Medicine

|July 11, 2025

Abstract

Background:

Serotonin reuptake inhibitors (SSRIS) and cognitive behavior therapy (CBT), comprising exposure and response prevention (ERP), are the first line of treatment for obsessive compulsive disorders (OCD). However, many patients fail to achieve clinically significant symptom relief from traditional exposure-based therapies. This has led to research on strategies that can optimize the effects of ERP. Inhibitory learning theory (ILT) provides a novel foundation for understanding how exposure therapy reduces fear and has been mainly studied in the context of anxiety and phobia.

Novelty:

There is limited empirical data on applying the principles of IL, such as expectancy violation, variability, deepened extinction, labelling of affect, and removal of safety signals as mechanisms of extinction that can aid the achievement of favorable outcomes in OCD. In the absence of an existing manual, we describe the development of a novel IL-based ERP therapy intervention and the trial protocol to test its efficacy in patients with OCD.

Methods:

A quasi-experimental study design with baseline, post-treatment, and follow-up assessments will be adopted. The first phase of this study includes developing and validating an IL-based ERP intervention. A sample of 24 patients diagnosed with OCD will be recruited to receive IL-based ERP as part of the study. Measures of OCD symptom severity will be used to test efficacy.

Expected Outcome:

This study describes the development of an OCD-specific IL-based ERP intervention and an open-label trial to generate preliminary evidence for its utility in persons with OCD. The use of IL principles in ERP may potentially improve treatment outcomes for OCD.

Keywords:

Cognitive flexibility exposure response prevention therapy inhibitory learning intolerance to uncertainty obsessive-compulsive disorder (OCD)psychological flexibility

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