Do Exposure Therapy Processes Impact the Efficacy of Deep TMS for Obsessive-Compulsive Disorder?

SOURCE: Journal of Obsessive-Compulsive and Related Disorders. 35 (no pagination), 2022. Article Number: 100756.


AUTHORS: Guzick A.G.; Schweissing E.; Tendler A.; Sheth S.A.; Goodman W.K.; Storch E.A.

ABSTRACT: This study evaluated exposure therapy processes during symptom provocation in a randomized sham-controlled trial of deep transcranial magnetic stimulation (Deep TMS) for 99 adults with obsessive-compulsive disorder (OCD). The following factors were expected to lead to more symptom improvement, particularly in active relative to sham groups: 1) progression to more hierarchy items, 2) greater distress during provocations, 3) between-session habituation, and 4) variability in distress during provocations. Participants were randomized to six weeks of daily symptom provocation plus sham or active Deep TMS of the dorsal medial prefrontal cortex and anterior cingulate cortex. Obsessive-compulsive symptoms were assessed weekly and at four-week follow-up. No significant predictors were identified though increased distress moderated outcomes (b = -.041, p = .048); those who reported more distress during provocations had an improved active vs. sham response, though there was less of a difference between active and sham for those who reported less distress. Lack of an association between other exposure processes and treatment outcome may suggest differences between Deep TMS provocations and exposure exercises.

?? Higher distress during provocations corresponded with greater active vs. sham Deep TMS efficacy.
?? No exposure processes tested during Deep TMS provocations predicted improved symptom reduction.
?? Symptom provocations during Deep TMS for OCD appear distinct from exposure tasks.