Doing More Helps More: Obsessive Compulsive Symptoms and Quality of Life Improved with Larger Number of Exposure and Response Management Therapy Sessions in Specialised Inpatient Settings

<p>The number of sessions of exposure and response management therapy (ERT) required for meaningful improvement in obsessive–compulsive disorder (OCD) remains unclear, particularly in specialised inpatient care. The present study examined whether the number of exposure sessions during inpatient treatment was associated with improvement of OCD symptoms and quality of life at discharge.We conducted a retrospective analysis of routinely collected clinical data from patients treated for OCD in a specialised inpatient setting. The analysed sample comprised N = 407 patients. OCD symptom severity was assessed with the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and quality of life (QoL) with the Satisfaction with Life Scale (SWLS). ERT dose was operationalised as number of ERT sessions per week and the total sum of therapist-guided ERT sessions. Bayesian regression models estimated associations with discharge OCD and QoL while controlling, based on a directed acyclic graph, for baseline symptom severity, baseline QoL where appropriate, duration of inpatient stay and clustering by ward. The total sum of ERT sessions were associated with lower discharge OCD and higher discharge QoL. For OCD, the pattern further suggested diminishing returns, such that additional ERT sessions were still associated with benefit, but the incremental benefit became smaller at higher treatment doses. In contrast, weekly ERT session frequency was not substantially associated with either discharge OCD or discharge QoL. These findings support the clinical relevance of cumulative ERT sessions in specialised inpatient OCD treatment, while prospective studies with objective treatment documentation are needed to clarify causality and optimal dose.</p>