Utilizing Cognitive Assessment to Predict Exposure and Response Prevention Treatment Response

Abstract

Exposure and response prevention (ERP) is the first-line treatment for the obsessive-compulsive disorder (OCD). However, a substantial portion of individuals in treatment may not see benefit, and efforts to find predictors of treatment outcomes have been challenging. Response inhibition (RI), which has been linked to OCD symptoms, is theoretically promising as a predictor of ERP treatment outcomes. In this study, we utilized inhibitory capabilities, measured at admission to partial hospitalization programs (PHP) at Rogers Memorial Hospital, to predict treatment outcomes in ERP. We hypothesized that worse performance in RI subdomains of action cancellation, action withholding, and interference control, as well as error-monitoring sub-processes within these domains, would be associated with worse treatment outcomes. Though we did not find overall indices of RI (e.g., stop signal reaction time) were associated with response to ERP, we found that excessive slow down following errors in the context of the stop-signal task was associated with less symptom reduction. On a fast-paced measure of action withholding, longer overall reaction time and slow-down following successful inhibition were both associated with worse treatment outcomes. Together, our data suggests that individuals who are less likely to see symptom reduction in ERP show an oscillatory responding style involving slow-down and speed-up at inappropriate times. Our findings may help inform ritual prevention procedures, as well as the feasibility of utilizing cognitive assessment in the clinical context.