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Serious negative consequences associated with exposure and response prevention for obsessive‐compulsive disorder: A survey of therapist attitudes and experiences
Author(s) -
Schneider Sophie C.,
Knott Lindsey,
Cepeda Sandra L.,
Hana Lynn M.,
McIngvale Elizabeth,
Goodman Wayne K.,
Storch Eric A.
Publication year - 2020
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.23000
Subject(s) - psychology , harm , clinical psychology , exposure and response prevention , obsessive compulsive , psychotherapist , psychiatry , social psychology
Objective Many therapists are reluctant to conduct exposure and response prevention (ERP) for obsessive‐compulsive disorder (OCD). Negative beliefs about the safety and tolerability of ERP are common, especially for harm‐related OCD symptoms. The study examined the nature and frequency of ERP‐related serious negative consequences (SNC) and therapist attitudes and experiences providing ERP for harm‐related OCD. Methods An anonymous survey was completed by 277 therapists with experience treating OCD using ERP. Questions assessed clinical experiences of harm‐related exposures, the nature of SNC, and concerns and clinical considerations regarding ERP. Results Therapist's willingness to treat harm‐related OCD was high. SNCs were reported for 6 clients (per‐client risk: adults 0.05%, youth 0.01%) and 13 therapists (per therapist risk 4.73%, therapist per‐year risk 0.004%). Qualitative analysis identified themes relating to the conduct of treatment, specific exposure types, professional issues, and negative perceptions of ERP. Conclusion SNC associated with ERP for OCD are rare and primarily represent unintended secondary consequences of OCD or misunderstandings regarding the process and rationale behind ERP. Improving access to ERP will require good communication with clients, families, and other professionals regarding the rationale and safety of ERP.