Exposure and Response Prevention to Improve Functioning in Veterans with Obsessive Compulsive Disorder

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Project Background Exposure and Response Prevention (ERP) is the gold standard evidence-based psychotherapy for OCD; however, few Veterans receive ERP and no randomized controlled trials (RCTs) have been published examining the effectiveness of ERP among Veterans or in individuals with comorbid OCD and posttraumatic stress disorder (PTSD). OCD impacts work, social, and family functioning, such that 38% of people with OCD are unable to work due to the severity of symptoms and 25% attempt suicide at some point in their lives (Mancebo et al., 2008). It is essential to examine the effectiveness of ERP in Veteran specific trials because Veterans are a complex, highly comorbid population, and have significant trauma histories which can complicate ERP treatment. Many Veterans face logistic barriers to accessing therapy including transportation, distance, childcare, and work, in addition to challenges leaving the home due to OCD symptoms. Video telehealth (VTH) can increase Veterans’ access to ERP and may enhance the generalizability of exposures since in-home exposure exercises can focus on OCD triggers that people encounter in their home environment. This may mean more direct impact to the Veteran’s daily life functioning and quality of life. Project Objectives The proposed 4-year multisite RCT will compare outcomes of VTH-delivered ERP to those of a stress management training control condition among 160 Veterans with OCD. Half of the sample with have comorbid PTSD. The primary aim will examine whether participants’ functioning, quality of life, and OCD symptoms differ as a function of the intervention (ERP vs. control). The secondary aim will examine these outcomes among the half of the sample with comorbid OCD and PTSD. The tertiary aim is to conduct a mixed-methods formative evaluation of the implementation potential of ERP in VA mental health settings. Project Methods Eligible Veteran participants will be randomized to ERP or to the control condition. Veterans randomized to ERP will receive 16 weekly ERP sessions delivered via VTH. Control participants will receive 16 weekly sessions of a stress management training intervention delivered via VTH. Participants in both conditions will complete assessments at post-treatment and 6 months after completing treatment. Participants in the ERP condition will also complete an assessment of treatment satisfaction and a qualitative exit interview assessing the Veterans’ perceptions of the impact of treatment on multiple domains of functioning, including the impact on PTSD symptoms. Providers and VA administrators will participate in qualitative interviews regarding the implementation potential of ERP in VA. Contribution to VHA This work addresses RR&D clinical priorities related to cognitive-behavioral interventions for improving Veterans’ functioning, participation in society, and quality of life. Establishing ERP as an evidence-based treatment in the complex Veteran population has the potential to impact the 170,000 Veterans in VHA with OCD and assist them in living more functional lives, which will affect their families, children, workplaces, and communities.