Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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强迫症的常见仪式及其对治疗的影响：一项混合方法研究。


强迫症 (OCD) 的特点是参与旨在获得确定性并防止可怕结果的仪式。当仪式受到抵制时，暴露和反应预防是最有效的，但现有的强迫症自我报告措施限制了对所有可能的仪式的识别，而且人们对仪式如何聚集在一起并预测恶化的严重性和较差的治疗结果知之甚少。在接受强化强迫症治疗的 641 名成年患者的回顾性样本中，本研究使用混合方法来 (a) 使用耶鲁-布朗强迫量表识别和验证治疗提供者确定的仪式，(b) 识别聚类仪式模式，以及（c）检查这些集群对严重程度和治疗结果的影响。六十二个离散的仪式聚集成八个更高阶的仪式群：回避、保证、检查、清洁/洗手、恰到好处、沉思、自信和所有其他仪式。入院时，安慰预示着对不确定性（IU）的更大的不容忍，而沉思则预示着强迫症的严重程度减轻。只有一个仪式组——恰到好处地预测了治疗结果；仪式正确的患者出院时 IU 较差，治疗时间明显更长（平均延长 7.0 天）。与单独的自我报告评估相比，临床观察可以识别出更细致和个性化的仪式。表现得恰到好处的仪式的患者可能从专注于避免伤害和习惯的治疗中获益较少；相反，治疗应该针对不完整的特质而不仅仅是正确的经历。 （PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。