A new Psychotherapy Research analysis by Nielsen and colleagues examined predictors and moderators of outcome among 176 adults with OCD who had been randomized to 14 sessions of group CBT with exposure and response prevention or group Acceptance and Commitment Therapy.
Contrary to a plausible treatment-matching assumption, participants with greater anxiety sensitivity, experiential avoidance, and emotion-regulation difficulties tended to benefit more from CBT with ERP than from ACT. Group therapeutic alliance was also associated with treatment response. These are preliminary moderator findings from a sample not designed to establish definitive treatment-selection rules, so they require replication.
Clinical Takeaway: Do not assume that a patient’s high experiential avoidance or difficulty tolerating emotion means that ERP should be postponed in favor of a primarily acceptance-based treatment. ERP can remain the central intervention, while ACT strategies are used to increase willingness, reduce struggle with internal experiences, clarify valued reasons for approaching feared situations, and help the patient persist without ritualizing. In group treatment, alliance and cohesion should be monitored rather than treated as nonspecific background variables.