Does Imagined Exposure to the Consequences of Not Ritualising Enhance Live Exposure for OCD? a Controlled Study

Abstract

BackgroundThis study tested whether adding imagined exposure to live exposure would increase the concordance between behavioural and subjective improvement in obsessive–compulsive disorder (OCD).Method46 OCD out-patients were randomly allocated to 9 weekly sessions of either combined live + imagined exposure/ritual prevention (Exi, n = 23), or only live exposure/ritual prevention (Ex, n = 23). Patients were asked to do 90 min of daily self-exposure at home (corresponding to Exi or Ex). Measures were: (A) behavioural; (B) subjective; (C) clinical global impression (CGI).ResultsAfter 9 weeks of treatment, improvement was greater on behavioural than subjective measures (similar for the Exi and Ex groups). At 20 weeks (3-month follow-up) each group had improved slightly more on subjective measures and slightly less on behavioural ones. Two subjective measures improved less during Exi than Ex, but this difference disappeared at follow-up. The greater difference between behavioural and subjective improvement scores in Exi than in Ex did not relate to clinical outcome at the end of treatment or follow-up.ConclusionsCompared to live exposure alone, combined imagined plus live exposure did not enhance behavioural/subjective concordance.