Change in obsessive beliefs in therapist-directed and self-directed exposure therapy for obsessive-compulsive disorder

Self-directed treatment may be a cost-effective adjunctive or stand-alone intervention for obsessive-compulsive disorder (OCD) and related problems. Current cognitive-behavioral theories suggest that disconfirmation of maladaptive beliefs about feared stimuli is a mechanism of change in exposure-based treatments. It is unclear whether self-directed exposure therapy results in the same degree of change in maladaptive beliefs as traditional therapist-directed exposure. The current study used data from a published trial of self-directed and therapist-directed exposure therapy for OCD (N = 41; Tolin et al., 2007) to compare change in obsessive beliefs between the two treatments. The original trial found superior treatment outcomes for patients in the therapist-directed condition as compared to the self-directed condition. Piecewise linear growth modeling demonstrated that therapist-directed exposure resulted in greater change in obsessive beliefs from pre-treatment through 6-month follow-up than did self-directed treatment. Post-treatment obsessive beliefs mediated post-treatment OCD symptoms in both treatment conditions, suggesting that treatment effects were at least in part due to change in obsessive beliefs. The findings suggest that therapist-directed exposure leads to greater cognitive change than does self-directed treatment, and are discussed in terms of cognitive-behavioral theory and potential ways to promote belief change in therapist- and self-directed treatment.