Intensive residential treatment for obsessive-compulsive disorder: Outcomes and predictors of patient adherence to cognitive-behavioural therapy

• We examined effectiveness and adherence to CBT for those with OCD symptoms attending IRT.
• IRT resulted in significant improvements to OCD and comorbid symptoms.
• We found patient adherence to EX/RP predicted reductions in OCD symptoms.
• Specific illness and treatment characteristics were associated with adherence to EX/RP within IRT settings.

Obsessive-compulsive disorder (OCD) is often a severe and highly debilitating disorder, in which many patients inadequately respond to standard outpatient care. While specialized intensive residential treatment (IRT) for OCD provides promise, factors to improve treatment adherence in these settings is currently unknown but crucial to optimize treatment response. This naturalistic study examined the rates and predictors of patient adherence to exposure and response preventions (EX/RP) for 49 patients attending IRT. A therapist assessed between-session adherence to EX/RP, and participants completed self-report measures at pre- and post-treatment, and 1-month follow-up. Linear mixed effects models analyses revealed that IRT resulted in significant improvements in OCD and comorbid symptoms. Treatment readiness, specific obsessional beliefs, depression and stress symptoms, level of insight, avoidance, and responsibility for harm were significantly associated with patient adherence. Directions for future research that may interact with adherence to EX/RP and lead to targeted interventions are discussed.