A Pilot Study: Augmentation of Outpatient Exposure and Response Prevention with Peer-Led OCD Support Group Participation for Individuals with OCD

Background: The World Health Organization reported a 5.8% lifetime prevalence for obsessive-compulsive disorder (OCD) in developing countries and a 6.9% lifetime prevalence for OCD in developed countries (Öst et al., 2022). OCD is associated with substantial work disruption and low quality of life for individuals with the disorder (Garcia-Soriano et al., 2014). Success of exposure and response prevention therapy (ERP), which is a sub-type of Cognitive Behavioral Therapy (CBT), in treating OCD has been well documented (Ferrando & Selai, 2021; Abramowitz, 1996). Studies have shown that peer-led behavioral groups were as effective as therapist-led CBT groups (Mathews et al., 2016). Improved quality of life is noted as a reason to support the addition of peer support workers to mental health (Shalaby & Agyapong, 2020). Combining the impact of ERP for individuals with peer support has the potential to amplify the positive impact on treating OCD but has not been tested. Research Question: Will OCD peer support group participation enhance ERP treatment results and quality of life in individuals with OCD? This study aims to pilot the addition of peer support to individual ERP compared to individual ERP alone through analysis of pre-post OCD symptom and quality of life measures.

Methods: This study used a quasi-experimental design with purposive sampling at a mental health clinic specializing in ERP with an established weekly peer-led OCD support group. English versions of the Yale-Brown Obsessive-Compulsive Scale – Self Report (-Y-BOCS-SR) (Goodwin, Price, Rasmussen, et al., 1989) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire – Short Form (Q-LES-Q-SF) (Endicott, Nee, Harrison, & Blumenthal) were administered to subjects in individual outpatient (n=6) and subjects in group and individual ERP (n=6) prior to week 1 (baseline/pre) session and after week 6 (post) session, outside of session time. Descriptive statistics were calculated for the group characteristics. Group differences were assessed using t-tests when possible; however, to look at clinical group-level effects while controlling for within-subject change, Hedge’s g scores (using a pooled standard deviation) were also calculated. R (v4.0.3) and Excel were used to analyze the data.

Results: Controlling for within-subject change and looking at hedge’s g scores showed clinical effects of the peer-group. Q-LES-Q-SF current health or work life scores indicated an overall positive change in the quality of life for peer-group recipients (g=0.51). Peer-group participants together indicated a larger reduction in obsessions on average (M=-1.8, SD=2.2) than individual ERP only participants (M=-0.5, SD=2.7), with a modest between group effect difference (g=-0.55). The compulsions scores showed a larger average decline for individual session only participants (M=-2.0, SD=1.9) versus peer support participants (M=-1.2, SD=1.8). This effect was in the direction of the individual support group (g=0.45). Overall, the combined 10-item scale showed a small, combined benefit for the peer-group participants (g=-0.14).

Conclusions and Implications: This study showed early trends in positive change in ERP treatment enhancement and quality of life scores for subjects adding a brief peer-led OCD support group delivered conjointly to individual ERP treatment. Additional research is needed to fully assess effectiveness; however, trends were overall positive.