The Relative Impact of Cognitive and Behavioral Skill Comprehension and Use During CBT for Obsessive Compulsive Disorder

During cognitive-behavioral therapy (CBT) for Obsessive Compulsive Disorder (OCD), individuals learn to utilize cognitive and behavioral skills to manage their symptoms. However, it is unclear whether these CBT skills have similar effects on symptom alleviation throughout treatment. This study examined the impact of CBT skill comprehension and CBT skill frequency on OCD symptom change during CBT for OCD. Participants experiencing a primary diagnosis of OCD (N = 101) completed self-report measures of OCD symptoms, skill comprehension (e.g., using the Skills of Cognitive Therapy Questionnaire (SoCT)), and skill frequency (i.e., comparing the thought record (TR) with exposure and response prevention (ERP)) during treatment. Structural equation modelling analyses involving an integration of growth curve analysis and cross-lagged regression analysis demonstrated that skill comprehension and skill frequency trajectories are associated with OCD symptom trajectories. There was a significant cross-lagged relationship between skill comprehension and OCD symptom change, in which higher levels of skill comprehension were associated with OCD symptom alleviation. Comparable analyses of skill frequency demonstrated that higher levels of both TR frequency and ERP frequency were associated with improvements in OCD symptoms. These results demonstrate that higher levels of skill comprehension as well as skill frequency are associated with OCD symptom alleviation.