DOES IMAGINED EXPOSURE TO THE CONSEQUENCES OF NOT RITUALISING ENHANCE LIVE EXPOSURE FOR OCD - A CONTROLLED-STUDY .2. EFFECT ON BEHAVIORAL V SUBJECTIVE CONCORDANCE OF IMPROVEMENT

Background. This study tested whether adding imagined exposure to live exposure would increase the concordance between behavioural and subjective improvement in obsessive-compulsive disorder (OCD). Method. 46 OCD out-patients were randomly allocated to 9 weekly sessions of either combined live+imagined exposure/ritual prevention (Exi, n=23), or only live exposure/ritual prevention (Ex, n=23). Patients were asked to do 90 min of daily self-exposure at home (corresponding to Exi or Ex). Measures were: (A) behavioural; (B) subjective; (C) clinical global impression (CGI). Results. After 9 weeks of treatment, improvement was greater on behavioural than subjective measures (similar for the Exi and Ex groups). At 20 weeks (3-month follow-up) each group had improved slightly more on subjective measures and slightly less on behavioural ones. Two subjective measures improved less during Exi than Ex, but this difference disappeared at follow-up. The greater difference between behavioural and subjective improvement scores in Exi than in Ex did not relate to clinical outcome at the end of treatment or follow-up. Conclusions. Compared to live exposure alone, combined imagined plus live exposure did not enhance behavioural/subjective concordance.