(PS3-C74) The Relationship Between Changes in Perfectionistic Cognitions and Obsessive-compulsive Symptoms in Exposure and Response Prevention

Perfectionism is a personality trait marked by excessive striving and subsequent distress regarding unmet performance standards, and perfectionistic cognitive processes may contribute to the etiology and maintenance of OCD. There is mixed evidence that changes in more global perfectionistic beliefs may partially mediate symptom reduction in cognitive-behavioral therapy for OCD. While some research supports the significance of perfectionistic beliefs in OCD, studies have shown that frequently occurring perfectionistic automatic thoughts may better account for the unique variance in automatic thoughts specific to clinical diagnoses. We propose that frequently occurring automatic perfectionistic cognitions (PCs) may be more directly related to OCD symptoms. The current study examined 1) changes in the self-reported frequency of past week perfectionistic cognitions during EXRP for OCD and 2) whether observed changes in PCs correlated with changes in OCD symptoms.

Participants were 52 adults diagnosed with OCD, seeking treatment in an outpatient OCD and anxiety specialty clinic. Treatment plans consisted of 10-20 sessions of EXRP delivered naturalistically. PCs were assessed using the Perfectionistic Cognitions Inventory (PCI), a 25-item self-report measure of the frequency of automatic thoughts related to perfectionistic beliefs in the past week. OCD symptoms were assessed using the Obsessive Compulsive-Inventory (OCI-R). The PCI and OCI-R were administered pre and post treatment. To examine change in PCs over treatment and the potential impact on OCD symptoms post treatment, we computed standardized residual scores of the PCI and OCI-R and tested the correlation between them.

Amongst patients diagnosed with OCD, there was a significant reduction in scores on the PCI from pre (M = 38.98, SD = 26.40) to post (M = 29.17, SD = 24.26) treatment [t(51) = 4.08, p <  0.001, Cohen’s d = 0.57], as well as OCD symptoms pre (M = 19.75, SD = 11.82) to post (M = 11.51, SD =  9.56) treatment [t(52) = 5.87, p <  0.001, Cohen’s d = .81]. There was a significant correlation between changes in PCs and OCD symptoms from baseline to post treatment [r = 0.37, p < 0.01].

The frequency of PCs reduced over the course of EXRP treatment, and this decrease was correlated with reductions in OCD symptoms in individuals diagnosed with OCD. These results may suggest that EXRP can indirectly reduce the frequency of perfectionistic thinking, which in turn is related to OCD symptom reduction. These findings indicated that it may be worth considering PCs as a relevant factor in understanding how OCD symptoms improve in EXRP. Future work should include additional variables know to be associated with OCD symptoms such as intolerance of uncertainty and examine the frequency of PCs as a potential mediator of treatment response in EXRP.