Center for Medical Ethics and Health Policy Staff Publications
Publication Date
9-1-2023
Journal
Psychological Assessment
DOI
10.1037/pas0001254
PMID
37470990
PMCID
PMC10527485
PubMedCentral® Posted Date
9-1-2024
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Adult, Humans, Ceremonial Behavior, Retrospective Studies, Obsessive-Compulsive Disorder, Compulsive Behavior, Treatment Outcome, Obsessive-compulsive disorder, rituals, treatment outcomes, mixed methods, agglomerative hierarchical clustering
Abstract
Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).