The Relationship Between Baseline Levels of Obsessive- Compulsive Symptom Severity,  Self-Efficacy, and Experiential Avoidance in Patients with Obsessive-Compulsive Disorder

Background: Obsessive-compulsive disorder (OCD) is a debilitating and pervasive disorder involving persistent preoccupations with intrusive thoughts (obsessions) and ritualized actions or behaviors (compulsions). Investigating the mechanisms underlying the development, maintenance, and treatment outcome can increase our understanding of the heterogeneity of the OCD population. One factor that may affect OCD symptom severity is self-efficacy, which is the belief in one’s capacity to perform necessary behaviors for goal attainment. Another potential factor is experiential avoidance, the avoidance of negatively perceived inner experiences including thoughts, emotions, memories, or physical sensations. This cross-sectional study is embedded in the 3D (Doorbreek Dwang Digitaal) study, which is a randomized controlled trial investigating the treatment effects of treatment for OCD by comparing exposure as usual and a personalized online approach to this therapy. The present study aimed to...Show moreBackground: Obsessive-compulsive disorder (OCD) is a debilitating and pervasive disorder involving persistent preoccupations with intrusive thoughts (obsessions) and ritualized actions or behaviors (compulsions). Investigating the mechanisms underlying the development, maintenance, and treatment outcome can increase our understanding of the heterogeneity of the OCD population. One factor that may affect OCD symptom severity is self-efficacy, which is the belief in one’s capacity to perform necessary behaviors for goal attainment. Another potential factor is experiential avoidance, the avoidance of negatively perceived inner experiences including thoughts, emotions, memories, or physical sensations. This cross-sectional study is embedded in the 3D (Doorbreek Dwang Digitaal) study, which is a randomized controlled trial investigating the treatment effects of treatment for OCD by comparing exposure as usual and a personalized online approach to this therapy. The present study aimed to investigate the relationship between baseline levels of self-efficacy, experiential avoidance, and OCD symptom severity in patients with OCD. Methods: To this end, the baseline questionnaires of self-efficacy (the Self-Efficacy Questionnaire for OCD; SEQ-OCD) and experiential avoidance (the Avoidance and Acceptance Questionnaire; AAQ-II), and a structured interview for OCD symptom severity (Yale-Brown Obsessive Compulsive Scale; Y-BOCS) were used. A multiple linear regression model tested the relationship between baseline scores on the SEQ-OCD, AAQ-II, and Y-BOCS of 40 participants diagnosed with OCD. Consecutively, a hierarchical and a k-means clustering analysis were performed, to form clusters of participants using the SEQ-OCD, AAQ-II, and Y-BOCS baseline scores. Results: Results showed that self-efficacy had a significant negative relationship with OCD symptom severity, as higher levels of self-efficacy were associated with a lower level of OCD symptom severity. However, this relationship was not significant anymore when experiential avoidance was added to the model. Experiential avoidance was not significantly related to OCD symptom severity or self-efficacy. With hierarchical and k-means clustering, two clusters were identified that significantly differed in levels of self-efficacy, OCD symptom severity, and experiential avoidance. One cluster showed significantly higher levels of OCD symptom severity and experiential avoidance and significantly lower levels of self-efficacy. This cluster also experienced more obsessions involving contamination, religion, symmetry/ordering, and more compulsions involving cleaning and counting. Conclusion: This study indicates that there is a relationship between self-efficacy and OCD symptom severity. Moreover, we found evidence of distinct groups of OCD patients with different levels of self-efficacy, OCD symptom severity, experiential avoidance, and different OCD symptom subtypes. This may indicate a differential role of self-efficacy and experiential avoidance across the different OCD symptom subtypes. Limitations of this study included the small sample size and the overrepresentation of females and the contamination obsession subtype. Future studies using larger sample sizes and a more diverse sample are required to further establish the precise mechanism of self-efficacy and symptom subtype in the development and maintenance of OCD.Show less

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The Relationship Between Baseline Levels of Obsessive- Compulsive Symptom Severity, Self-Efficacy, and Experiential Avoidance in Patients with Obsessive-Compulsive Disorder