Long-Term Follow-up Study of Obsessive-Compulsive Patients after Exposure Treatment

Summary

After treatment by exposure in vivo and response prevention, forty-nine out of sixty-two obsessive-compulsive patients were followed for approximately 3.5 years. Compared to participators, the thirteen patients who did not participate had more initial obsessive-compulsive (OC) anxiety and depression, which nevertheless improved similarly by posttreatment. At 3.5 years follow-up, gains were maintained on all measures with no relapse. Eighty-four percent of the patients were “improved” or “much improved”, indicating that exposure in vivo and response prevention was successful in the treatment of obsessive compulsive disorders.

A number of initial patient characteristics only marginally predicted therapy outcome. Approximately one quarter of the total variance could be explained. The predictor variables, however, discriminated about sixty to seventy percent of good from poor therapy outcomes at posttreatment and long-term follow-up respectively. Higher initial OC-anxiety and depression, higher onset age, and more negative rearing practices resulted in poorer therapy outcome.

The effectiveness of behavioral treatment for obsessive-compulsive disorders has been demonstrated in a number of studies (for an overview see Emmelkamp, 1982). One of the most successful treatments found, was exposure in vivo and response prevention. In these studies, the follow-up of treatment effects occurred mainly between one and six months after treatment Follow-up studies after approximately two years were reported by Boulougouris (1977), Kasvikis & Marks (1988), Marks et al. (1975), and Mawson et al. (1982).

The aim of the present study was to evaluate the effects of behavioral treatment approximately 3.5 years after treatment. A further aim of this study was to examine the possible relationship of patient characteristics to therapy outcome at posttreatment and follow-up after 3.5 years. The selection of the prognostic variables to be investigated was partly based on the results of previous investigations of Foa et al. (1983) and Hoogduin & Duivenvoorden (1988). In the Foa et al. study (1983), onset age, initial depression, and initial obsessive-compulsive anxiety were found to correlate with outcome at posttreatment or follow-up.

Since negative parental rearing practices (rejection by the parents, lack of emotional warmth, and overprotection) have been found to be associated with obsessive compulsive disorders (Emmelkamp, 1982; Hoekstra, Visser & Emmelkamp, 1989), the present study also adressed the question of whether parental characteristics affect treatment outcome.