Obsessive-compulsive personality disorder in radically open dialectical behavior therapy for treatment-refractory...

Area of Science:

• Psychiatry and Psychology
• Clinical Psychology
• Psychosocial Interventions

Background:

• Obsessive-Compulsive Personality Disorder (OCPD) frequently co-occurs with Major Depressive Disorder (MDD), leading to poorer prognoses and treatment resistance.
• Radically Open Dialectical Behavior Therapy (RO DBT) is a novel transdiagnostic intervention targeting OCPD-related traits like maladaptive perfectionism and inflexibility.
• RO DBT has been theoretically proposed as a treatment for OCPD, but its efficacy in comorbid conditions requires empirical investigation.

Purpose of the Study:

• To examine the efficacy of RO DBT, when added to treatment as usual (TAU), for individuals with treatment-refractory depression (TRD), with or without comorbid OCPD.
• To assess the impact of RO DBT on depression symptoms, emotional approach coping, psychological flexibility, and interpersonal functioning.
• To determine if the presence of OCPD moderates the treatment effects of RO DBT in individuals with TRD.

Main Methods:

• A secondary analysis of the multisite randomized controlled trial RefraMED (N = 250) comparing RO DBT + TAU versus TAU for TRD.
• Linear regression models were used to predict 7-month (end of treatment) and 12-month (follow-up) symptoms, controlling for baseline symptom severity.
• Analyses examined outcomes for participants with OCPD, outcomes among participants receiving RO DBT (comparing OCPD vs. no OCPD), and OCPD's moderating role in treatment effects.

Main Results:

• At 12-month follow-up, participants with OCPD receiving RO DBT + TAU showed significant improvements in emotional approach coping and psychological flexibility compared to TAU alone (FDR-adjusted p = .008).
• No significant differences were found in depression severity or interpersonal functioning between RO DBT + TAU and TAU groups for participants with OCPD.
• OCPD presence did not predict outcomes within the RO DBT group and did not moderate the overall treatment effects, indicating RO DBT's benefits were not inhibited by comorbid OCPD.

Conclusions:

• RO DBT demonstrates potential as an evidence-based treatment for OCPD, particularly when comorbid with TRD, by enhancing emotional approach coping and psychological flexibility.
• Treatment effects of RO DBT were found to be equivalent for individuals with and without comorbid OCPD.
• RO DBT may offer specific benefits for improving emotional regulation and cognitive flexibility in individuals with OCPD and TRD.