A thematic analysis of barriers and facilitators to patient engagement in group exposure and response prevention therapy for obsessive compulsive disorder

Exposure and Response Prevention (ERP) is the gold standard in the treatment of obsessive-compulsive disorder (OCD). It can be delivered effectively using an individual or group therapy format. Nonetheless, a sizeable proportion of patients do not experience OCD symptom remission following ERP. Research suggests that patient engagement with ERP tasks predicts therapy outcomes but there is little consistent evidence across studies on what predicts engagement. A recent meta-analysis of patient adherence to CBT for OCD found that group ERP had a comparatively lower dropout rate than individual ERP. Little is known about patient perceptions of ERP to guide an understanding of how the group therapy format may affect patient engagement. This study conducted a qualitative exploration of what helps or hinders patients’ engagement in group ERP. It involved a thematic analysis of semi-structured interview data collected at six-month follow-up from 15 adults with OCD who took part in group ERP. The study identified five main themes that captured participants’ perceived facilitators and barriers to engagement in therapy: ‘Understanding how to overcome OCD’, ‘Personal relevance’, ‘Group processes’, ‘Patient attitudes towards ERP’ and ‘Personal circumstances’, which captured dynamically inter-related barriers and facilitators at the level of the client, therapist, therapy and social environment. Each theme and associated sub-themes are discussed in turn, followed by a consideration of the study’s limitations and implications.