Changes in obsessive-compulsive symptom profiles in response to exposure and response prevention

Exposure and response prevention (EX/RP) is a first-line psychological treatment for obsessive-compulsive disorder (OCD), yet treatment response varies across individuals. Given the substantial heterogeneity in OCD symptom presentations, examining changes in obsessive-compulsive (O-C) symptom profiles, rather than overall symptom severity, may clarify why patients respond differently to treatment. Accordingly, this study aimed to identify O-C symptom profile classes across treatment and to characterize transitions between classes during EX/RP.

The sample included 152 patients with OCD from two clinical trials that delivered 17 twice-weekly EX/RP sessions over 8 weeks, with assessments conducted at baseline, midpoint and post-treatment. Latent profile analysis was used to identify O-C symptom profiles at each time point, followed by latent transition analysis to examine how individuals transitioned between profile classes over time.

Distinct O-C profiles were identified at each time point, reflecting varying severity across Obsessive-Compulsive Inventory-Revised dimensions. Most patients maintained stable profiles with reduced overall symptom severity across treatment, supporting EX/RP's effectiveness. However, some profiles-particularly those characterized by elevated neutralizing symptoms-showed more variable transitions. A novel profile emerged at midpoint, with lower baseline avoidance predicting the membership.

These findings suggest that meaningful clinical information is gained by monitoring changes in O-C symptom profiles alongside overall severity during EX/RP. In particular, elevated neutralizing symptoms may signal a more variable response, whereas hoarding elevations may warrant early identification and proactive planning for targeted strategies beyond standard EX/RP. Incorporating profile-based monitoring into clinical practice may help clinicians more precisely tailor EX/RP to maximize therapeutic benefit.