(PS3-C57) The Effect of Disgust Propensity and Sensitivity on Distress During Exposure Tasks for Youth with OCD

Background

Exposure is an effective treatment for OCD, but not all patients respond. Eliciting distress is necessary for exposure effectiveness. Distress decrease during exposure (e.g., habituation) may also relate to treatment response. To examine variability in OCD treatment response, researchers have assessed factors associated with distress elicitation and decrease during exposure. Disgust propensity and sensitivity are two such factors that are often elevated in OCD compared to other anxiety-related disorders and may affect distress during exposure. Experimental studies conducted with adults have found that distress associated with disgust may not decrease during exposure as quickly or as much as distress associated with fear, but no such studies have been conducted during clinical care or with pediatric populations. Thus, this study examined the effect of disgust propensity and sensitivity on distress during exposure among youth with OCD. We hypothesized that higher disgust propensity and sensitivity would predict higher distress and less distress decrease during exposure, as is consistent with existing experimental research with adults.

Method

Participants included 219 youth (M = 13 yrs, 54% female, 90% White) in an intensive outpatient OCD program who consented to participation in research. Measures included the clinician-report Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and patient-report Disgust Propensity and Sensitivity Scale (DPSS) collected at admission, as well as the patient-report Subjective Units of Distress Scale (SUDS) collected during exposure. A sampling procedure was used to avoid over-representation of data from patients with longer treatment lengths. Three exposures were randomly selected per patient: one from early, middle, and late in a patient’s treatment (N = 655 total exposure tasks). “Start” distress was defined as the first SUDS rating and “peak” distress as the highest SUDS rating reported during exposure.  “Distress decrease” was defined as the difference between the “peak” and the lowest SUDS rating reported after the peak. We used linear regression to examine the effect of disgust propensity and sensitivity on start distress, peak distress, and distress decrease, controlling OCD severity. We employed a Bonferroni correction to adjust for multiple testing.

Results

The average CY-BOCS score at admission was 28, indicating severe OCD symptoms. The average DPSS score at admission was 38, indicating moderate disgust propensity and sensitivity. Controlling for OCD severity, higher disgust propensity and sensitivity at admission predicted higher start (β = 0.15, p = .003) and peak (β = 0.12, p = .012) distress during exposure, but did not predict distress decrease during exposure (p > .05).

Discussion

Results suggest that disgust propensity and sensitivity affect exposure processes for youth with OCD such that youth with higher disgust propensity and sensitivity report higher distress during exposure, although they do not appear to differ in pattern of distress decrease during exposure. Findings can inform treatment planning. Future research should continue to examine the effect of disgust on exposure processes (e.g., habituation, fear learning) within clinical care.