ORIGINAL PAPER
Reducing anxiety and depression in OCD: a randomized controlled trial of exposure and response prevention therapy
1
Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
2
Department of Psychology, Bilesavar Branch, Islamic Azad University, Bilesavar, Iran
Submission date: 2024-11-10
Final revision date: 2025-11-07
Acceptance date: 2025-11-08
Online publication date: 2026-03-03
Corresponding author
Esmaeil Sadri Damirchi
Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
KEYWORDS
TOPICS
ABSTRACT
Background:
Obsessive-compulsive disorder (OCD) frequently co-occurs with anxiety and depression, intensifying psychological distress and functional impairment. Although exposure and response prevention (ERP) is well established for treating core OCD symptoms, its effects on these common comorbid emotional disturbances remain underexplored. This study aimed to evalu-ate rigorously the effectiveness of ERP in reducing both anxiety and depressive symptoms in adults with OCD.
Participants and procedure:
In a randomized controlled trial at Razi Clinic, Tabriz, Iran (April 2022–May 2023), 50 adults (18-60 years) meeting DSM-5 criteria for OCD were recruited and randomly assigned to either an ERP intervention group or a wait-list control group (n = 25 each). Both groups completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at baseline and after intervention. The ERP group received eight weekly 90-minute sessions. Data were analyzed using analysis of covar-iance (ANCOVA), controlling for baseline scores.
Results:
The ERP group demonstrated a significant reduction in anxiety scores, decreasing from 33.80 ± 4.15 to 24.24 ± 3.80 after treatment (p = .030), and in depression scores from 31.15 ± 3.20 to 17.44 ± 3.60 (p < .001). These improvements likely reflect ERP’s capacity to decrease avoidance behaviors and enhance emotion regulation.
Conclusions:
ERP is an effective evidence-based intervention not only for OCD’s core symptoms but also for co-occurring anxiety and depression. Incorporating ERP into routine clinical practice may therefore yield broader emotional benefits for individuals with OCD.
Obsessive-compulsive disorder (OCD) frequently co-occurs with anxiety and depression, intensifying psychological distress and functional impairment. Although exposure and response prevention (ERP) is well established for treating core OCD symptoms, its effects on these common comorbid emotional disturbances remain underexplored. This study aimed to evalu-ate rigorously the effectiveness of ERP in reducing both anxiety and depressive symptoms in adults with OCD.
Participants and procedure:
In a randomized controlled trial at Razi Clinic, Tabriz, Iran (April 2022–May 2023), 50 adults (18-60 years) meeting DSM-5 criteria for OCD were recruited and randomly assigned to either an ERP intervention group or a wait-list control group (n = 25 each). Both groups completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at baseline and after intervention. The ERP group received eight weekly 90-minute sessions. Data were analyzed using analysis of covar-iance (ANCOVA), controlling for baseline scores.
Results:
The ERP group demonstrated a significant reduction in anxiety scores, decreasing from 33.80 ± 4.15 to 24.24 ± 3.80 after treatment (p = .030), and in depression scores from 31.15 ± 3.20 to 17.44 ± 3.60 (p < .001). These improvements likely reflect ERP’s capacity to decrease avoidance behaviors and enhance emotion regulation.
Conclusions:
ERP is an effective evidence-based intervention not only for OCD’s core symptoms but also for co-occurring anxiety and depression. Incorporating ERP into routine clinical practice may therefore yield broader emotional benefits for individuals with OCD.
REFERENCES (45)
1.
Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psy-chiatry, 51, 407–416. https://doi.org/10.1177/070674....
2.
Ahmadi, S. M., Masjediarani, A., Bakhtiari, M., Davazdahemamy, M. H., & Mohamadian, R. (2019). Psychometric properties of Persian version of Beck Depression Inventory in coronary patients. Universa Medicina, 38, 33–40. https://doi.org/10.18051/UnivM....
3.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). APA Publishing.
4.
Bakhshaie, J., Geller, D. A., Wilhelm, S., McGuire, J. F., Small, B. J., Cepeda, S. L., Schneider, S. C., Murphy, T. K., Porth, R., & Storch, E. A. (2020). Temporal precedence of the change in obsessive-compulsive symptoms and change in depressive symptoms during exposure and response prevention for pediatric obsessive-compulsive disorders. Behaviour Research and Therapy, 133, 103697. https://doi.org/10.1016/j.brat....
5.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychomet-ric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. https://doi.org/10.1037//0022-....
6.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. Psychological Corpo-ration.
7.
Belli, G. M., Law, C., Mancebo, M., Eisen, J., Rasmussen, S., & Boisseau, C. L. (2023). Directionality of change in obsessive compulsive disorder and depression over six years of prospective follow-up. Journal of Psychiatric Research, 157, 162–167. https://doi.org/10.1016/j.jpsy....
8.
Berle, D., Starcevic, V., Wootton, B., Arnáez, S., & Baggio, S. (2023). A network approach to understanding obses-sions and compulsions. Journal of Obsessive-Compulsive and Related Disorders, 36, 100786. https://doi.org/10.1016/j.jocr....
9.
Blanco-Vieira, T., Radua, J., Marcelino, L., Bloch, M., Mataix-Cols, D., & do Rosário, M. C. (2023). The genetic epidemiology of obsessive-compulsive disorder: a systematic review and meta-analysis. Translational Psychia-try, 13, 230. https://doi.org/10.1038/s41398....
10.
Cohen, L., Manion, L., & Morrison, K. (2018). Research methods in education (8th ed.). Routledge.
11.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat....
12.
Fawcett, E. J., Power, H., & Fawcett, J. M. (2020). Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. The Journal of Clinical Psychiatry, 81, 19r13085. https://doi.org/10.4088/JCP.19....
13.
Feusner, J. D., Farrell, N. R., Kreyling, J., McGrath, P. B., Rhode, A., Faneuff, T., Lonsway, S., Mohideen, R., Jurich, J. E., Trusky, L., & Smith, S. M. (2022). Online video teletherapy treatment of obsessive-compulsive disorder using exposure and response prevention: Clinical outcomes from a retrospective longitudinal observational study. Journal of Medical Internet Research, 24, e36431. https://doi.org/10.2196/36431.
14.
First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2016). SCID-5-CV: Structured clinical interview for DSM-5 disorders: Clinician version. APA Publishing.
15.
Fouche, J. P., Groenewold, N. A., Sevenoaks, T., Heany, S., Lochner, C., Alonso, P., Batistuzzo, M. C., Cardoner, N., Ching, C. R. K., de Wit, S. J., Gutman, B., Hoexter, M. Q., Jahanshad, N., Kim, M., Kwon, J. S., Mataix-Cols, D., Menchon, J. M., Miguel, E. C., Nakamae, T., Phillips, M. L., … Stein, D. J. (2022). Shape analysis of subcorti-cal structures in obsessive-compulsive disorder and the relationship with comorbid anxiety, depression, and medication use: a meta-analysis by the OCD Brain Imaging Consortium. Brain and Behavior, 12, e2755. https://doi.org/10.1002/brb3.2....
16.
Ghassemzadeh, H., Rothbart, M. K., & Posner, M. I. (2017). Mechanisms of response prevention and the use of exposure therapy for obsessive-compulsive disorder. International Journal of Psychiatry, 2, 1–8.
17.
Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: a review and new directions. Indian Journal of Psychiatry, 61, S85–S92. https://doi.org/10.4103/psychi....
18.
Himle, J. A., Grogan-Kaylor, A., Hiller, M. A., Mannella, K. A., Norman, L. J., Abelson, J. L., Prout, A., Shunnarah, A. A., Becker, H. C., Russman Block, S. R., Taylor, S. F., & Fitzgerald, K. D. (2024). Exposure and response pre-vention versus stress management training for adults and adolescents with obsessive compulsive disorder: a randomized clinical trial. Behaviour Research and Therapy, 172, 104458. https://doi.org/10.1016/j.brat....
19.
Hodgson, R. J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy, 15, 389–395. https://doi.org/10.1016/0005-7....
20.
Kaur, R., Garg, R., & Raj, R. (2023). Quality of life among patients with obsessive compulsive disorder: Impact of stigma, severity of illness, insight, and beliefs. Industrial Psychiatry Journal, 32, 130–135. https://doi.org/10.4103/ipj.ip....
21.
Khesht-Masjedi, M. F., Omar, Z., & Masoleh, S. K. (2015). Psychometrics properties of the Persian version of Beck Anxiety Inventory in North of Iranian adolescents. International Journal of Educational and Psychological Researches, 1, 145–153. https://doi.org/10.4103/2395-2....
22.
Melchior, K., van der Heiden, C., Deen, M., Mayer, B., & Franken, I. H. (2023). The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder: a randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 36, 100780. https://doi.org/10.1016/j.jocr....
23.
Moreno Amador, B., Piqueras, J. A., Rodríguez Jiménez, T., Martínez González, A. E., & Cervin, M. (2023). Meas-uring symptoms of obsessive compulsive and related disorders using a single dimensional self report scale. Frontiers in Psychiatry, 14, 958015. https://doi.org/10.3389/fpsyt.....
24.
Mowrer, O. H. (1951). Two-factor learning theory: Summary and comment. Psychological Review, 58, 350–354. https://doi.org/10.1037/h00589....
25.
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47, 33–41. https://doi.org/10.1016/j.jpsy....
26.
Peeters, N., Stappenbelt, S., Burk, W. J., van Passel, B., & Krans, J. (2021). Schema therapy with exposure and re-sponse prevention for the treatment of chronic anxiety with comorbid personality disorder. British Journal of Clinical Psychology, 60, 68–76. https://doi.org/10.1111/bjc.12....
27.
Pozza, A., Starcevic, V., Ferretti, F., Pedani, C., Crispino, R., Governi, G., Luchi, S., Gallorini, A., Lochner, C., & Coluccia, A. (2021). Obsessive-compulsive personality disorder co-occurring in individuals with obsessive-compulsive disorder: a systematic review and meta-analysis. Harvard Review of Psychiatry, 29, 95–107. https://doi.org/10.1097/HRP.00....
28.
Radomsky, A. S., Alcolado, G. M., Dugas, M. J., & Lavoie, S. L. (2022). Responsibility, probability, and severity of harm: an experimental investigation of cognitive factors associated with checking-related OCD. Behaviour Re-search and Therapy, 150, 104034. https://doi.org/10.1016/j.brat....
29.
Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. A. (2021a). Cog-nitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: a systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 106, 152223. https://doi.org/10.1016/j.comp....
30.
Reid, J., Fineberg, N. A., Drummond, L., Laws, K., Vismara, M., Grancini, B., & Mpavaenda, D. (2021b). Obsessive-compulsive disorder: Does CBT with exposure and response (ERP) prevention work?.
32.
Remacle, F. (2022). Investigating sudden gains during virtual reality exposure therapy for a patient with anxiety dis-orders: a single-subject research design with an evidence-based practice approach [Master thesis]. University of Liège.
33.
Robbins, T. W., Vaghi, M. M., & Banca, P. (2019). Obsessive-compulsive disorder: Puzzles and prospects. Neuron, 102, 27–47. https://doi.org/10.1016/j.neur....
34.
Rosendahl, J., Bechinie, M., Gawlytta, R., Frenzl, D., & Strauss, B. (2024). Evidence-based group treatments for anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. Group Dynamics: Theory, Research, and Practice, 28, 148–162. https://doi.org/10.1037/gdn000....
35.
Sadri Damirchi, E., Mojarrad, A., Pireinaladin, S., Grjibovski, A. M. (2020). The role of self-talk in predicting death anxiety, obsessive-compulsive disorder, and coping strategies in the face of coronavirus disease (COVID-19). Iranian Journal of Psychiatry, 15, 182–188. https://doi.org/10.18502/ijps.....
36.
Sharma, L. P., Balachander, S., Thatikonda, N. S., Ganesh, U. M., Kishore, C., Bhattacharya, M., Thamby, A., Ts, J., Narayanaswamy, J. C., Arumugham, S. S., & Reddy, Y. J. (2024). Long-term impact of the COVID-19 pan-demic on obsessive-compulsive disorder. Psychiatry Research, 331, 115625. https://doi.org/10.1016/j.psyc....
37.
Simkin, V., Hodsoll, J., & Veale, D. (2022). The relationship between symptoms of obsessive-compulsive disorder and depression during therapy: a random intercept cross-lagged panel model. Journal of Behavior Therapy and Experimental Psychiatry, 76, 101748. https://doi.org/10.1016/j.jbte....
38.
Smith, M. S., Cairns, L., Pullen, L. S. W., Opondo, C., Fellmeth, G., & Alderdice, F. (2022). Validated tools to identi-fy common mental disorders in the perinatal period: a systematic review of systematic reviews. Journal of Af-fective Disorders, 298, 634–643. https://doi.org/10.1016/j.jad.....
39.
Song, Y., Li, D., Zhang, S., Jin, Z., Zhen, Y., Su, Y., & Li, X. (2022). The effect of exposure and response prevention therapy on obsessive-compulsive disorder: a systematic review and meta-analysis. Psychiatry Research, 317, 114861. https://doi.org/10.1016/j.psyc....
40.
Tadayonnejad, R., Wilson, A. C., Chu, S. A., Corlier, J., Citrenbaum, C., Ngo, T. D. P., Hovhannisyan, E., Ginder, N. D., Levitt, J. G., Wilke, S. A., Krantz, D., Bari, A. A., & Leuchter, A. F. (2022). Use of right orbitofrontal repeti-tive transcranial magnetic stimulation (rTMS) augmentation for treatment-refractory obsessive-compulsive disorder with comorbid major depressive disorder. Psychiatry Research, 317, 114856. https://doi.org/10.1016/j.psyc....
41.
Vargas, T., Damme, K. S., Ered, A., Capizzi, R., Frosch, I., Ellman, L. M., & Mittal, V. A. (2021). Neuroimaging markers of resiliency in youth at clinical high risk for psychosis: a qualitative review. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 6, 166–177. https://doi.org/10.1016/j.bpsc....
42.
Wake, S., Verde, A. D., Biagi, N., van Reekum, C. M., & Morriss, J. (2022). Just let me check: The role of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physio-logical indices during a checking task. International Journal of Psychophysiology, 179, 43–55. https://doi.org/10.1016/j.ijps....
43.
Wetterneck, C. T., Leonard, R. C., Adams, T. G., Riemann, B. C., Grau, P., & Franklin, M. E. (2020). The effects of depression on the treatment of OCD in a residential sample. Bulletin of the Menninger Clinic, 84, 12–33. https://doi.org/10.1521/bumc.2....
44.
White, S. J., Sin, J., Sweeney, A., Salisbury, T., Wahlich, C., Montesinos Guevara, C. M., Gillard, S., Brett, E., All-wright, L., Iqbal, N., Khan, A., Perot, C., Marks, J., & Mantovani, N. (2024). Global prevalence and mental health outcomes of intimate partner violence among women: a systematic review and meta-analysis. Trauma, Vio-lence & Abuse, 25, 494–511. https://doi.org/10.1177/152483....
45.
Wu, Y., Wang, L., Tao, M., Cao, H., Yuan, H., Ye, M., & Zhu, C. (2023). Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years. Epidemiology and Psychiatric Sciences, 32, e63. https://doi.org/10.1017/S20457....
Copyright: © Institute of Psychology, University of Gdansk This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2353-5571 |
| ISSN: | 2353-4184 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
