Effects of Exposure and Response Prevention Therapy on Stress and Sense of Coherence in Patients With Obsessive-Compulsive Disorder

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), Obsessive–Compulsive Disorder (OCD) is classified as a separate anxiety disorder class; in the OCD category and related disorders. Chronic OCD and the unpredictable nature of aggravating symptoms and inability to control self during illness generate stress among patients with OCD. Furthermore, OCD can reduce biopsychological health and overall quality of life in the affected individuals. The high prevalence of this disorder and the need of the community to intervene and challenge therapists with these patients have led researchers to constantly seek novel therapy approaches with the best efficacy and least adverse effects to offering to psychotherapists. Effective treatment for OCD is Exposure and Response Prevention (ERP). Thus, the current study aimed to determine the effects of ERP therapy on stress and Sense of Coherence (SOC) in patients with OCD.

This was a quasi–experimental study with a pretest–posttest and a control group design. The study population consisted of all men and women with OCD referring to clinics and counseling centers in Birjand City, Iran, in the second half of 2018. In total, 40 volunteers were selected and randomly assigned into the study groups (experimental & control). The inclusion criteria of the study participants were as follows: OCD (confirmation by a psychiatrist or clinical psychologist with a diagnostic interview based on DSM–5 and receiving a score of >10 in the Maudsley Obsessive–Compulsive Inventory (Goodman et al., 1989); having a minimum level of ninth–grade education; not receiving pharmacotherapy; volunteering to receive OCD treatment; over 18 years of age, and having the desire and ability to collaborate until the end of the research. The exclusion criteria included presenting physical or viral illnesses, the presence of neurological disorders, like epilepsy, a history of any type of concussion, and reluctance to attend the treatment sessions. ERP intervention was performed based on Stekette’s treatment plan (2007) in eight 90–minute sessions. The required data were collected by the stress subscale of Depression Anxiety Stress Scale (DASS)–42 (Lovibond & Lovibond, 1995) and the Sense of Coherence Scale (Antonovsky, 1993) before and after the intervention in the study groups. The obtained data were analyzed in SPSS using Chi–squared test and one–way Analysis of Covariance (ANCOVA). The level of significance was set at 0.05.

After the intervention, the stress scores in the experimental group were significantly decreased, compared to the controls (p<0.001). Besides, the SOC scores were increased in them (p<0.001). Eta coefficient values for stress and SOC were measured as 0.222 and 0.228, indicating the effects of ERP therapy on reducing stress and increasing SOC in patients with OCD.

The present research results revealed that ERP therapy is effective in reducing stress and increasing SOC in patients with OCD. Therefore, it is recommended that this treatment be used as a complementary approach to other psychosomatic disorders.