Feared consequences, fixity of belief, and treatment outcome in patients with obsessive-compulsive disorder

In this study we examined the degree to which the presence of feared consequences and poor insight into obsessive-compulsive symptoms influenced the efficacy of behavior therapy for Obsessive-Compulsive Disorder (OCD). We also examined whether beliefs associated with patients' obsessions changed following treatment. Twenty OCD patients, with and without articulated feared consequences, received treatment by exposure and response (ritual) prevention (EX/RP). Patients' degree of insight into the senselessness of their obsessional beliefs was measured. Those who articulated fears of disastrous consequences tended to benefit more from EX/RP than those who did not express such fears. However, patients who were extremely certain that their feared consequences would occur evidenced poorer outcome than patients with mild or moderate certainty, despite the reduction of such certainty at posttest.