Exposure and Response Prevention With Prolonged Exposure Approaches for Treating Co-Occurring PTSD and OCD

An exposure and response prevention (ERP) plus prolonged exposure (PE) treatment approach may be effective for patients with co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). These findings were published in the Journal of Obsessive-Compulsive and Related Disorders.

Patients (N=8) with co-occurring OCD and PTSD who received ERP+PE treatment at Rogers Behavioral Health System in the United States between 2018 and 2020 were retrospectively reviewed for this study. Both ERP and PE were exposure-based therapies with in-vivo exposures, but ERP emphasized tolerance of uncertainty whereas PE focused on discriminating between safe and unsafe stimuli. Changes to Yale Brown Obsessive-Compulsive Scale-Self-Report (Y-BOCS-SR) and PTSD Checklist for the Diagnostic and Statistical Manual-5th Edition (PCL-5) were evaluated.

The patients were 75.0% women, mean age of 29.4 (SD, 10.7) years, 75.0% were White, 75.0% were in the residential care program, they had been hospitalized for 108.62 (SD, 50.93) days, 75.0% had directly experience trauma, 62.5% had been sexually abused, baseline Y-BOCS-SR was 29.2 (SD, 6.6), and PCL-5 was 51.0 (SD, 10.8).

Primary OCD symptoms included contamination (62.5%), doubt (37.5%), just right (37.5%), and harm (25%). For 7 of the patients, the OCD symptoms intersected with their PTSD.

Between admission to discharge, Y-BOCS-SR scores decreased by 11.75 points (t, 3.40; P =.011). A clinically meaningful change in Y-BOCS-SR, defined as a 35% reduction was achieved by 62.5%. Stratified by patient, the change in Y-BOCS-SR ranged from -60% to +4%.

PCL-5 scores decreased by an average of 22.5 points (t, 4.90; P =.002) overall and a clinically meaningful change (10-points) was achieved by 87.5%. The change in PCL-5 ranged from -81% to +5%.

The major limitation of this study was the small sample size.

Study authors concluded, “The current study builds on previously published case studies by providing the first preliminary empirical support for concurrent treatment of OCD and PTSD. Additionally, it is the first known study to examine the combination of ERP and PE and yielded very promising findings regarding their effectiveness when used concurrently with a sample of patients with primarily dynamic comorbid OCD and PTSD presentations.”