Date of Award

Fall 2003

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Leslie, Lauren

Second Advisor

Melchert, Timothy P.

Third Advisor

Burkard, Alan W.


While it has been documented that cognitive-behavioral therapy with an emphasis on exposure and ritual prevention is an effective treatment for Obsessive-Compulsive Disorder (OCD), patients, families, employers, schools, insurance companies and managed care systems often pose many "real world" questions about treatment, i.e. How long will treatment take? How much will treatment cost? How effective is treatment over time? How will treatment change life? Many of these questions sparked interest in determining predictors for "successful" treatment outcome over time. It had been clinically observed that patients who completed 75% of their behavioral hierarchy in treatment appeared to maintain treatment gains over time, but there had been no research conducted to support that claim. It appeared necessary to explore whether or not the percent of hierarchy completed was a strong predictor of outcome and if indeed it was, what percent was the best predictor. It was hoped that answers to these questions would begin to further assist patients, families, clinicians, and insurance companies or managed care organizations in treatment planning for optimal outcome. While research supports the fact that exposure and ritual prevention helps to reduce symptoms of OCD, very little is known about how that symptom reduction might affect patients' quality of life. It would seem that as clinicians and researchers we should be interested in exploring both the reduction of symptoms for our patients and improvement in quality of life. The first purpose of this study was to explore whether treatment change or the percent of hierarchy completed predicted successful outcome at a 7-month follow-up. In addition, an attempt was made to determine what percent of hierarchy completed better predicted outcome. The second purpose of this study was to explore whether quality of life improved with treatment and whether it maintained, increased or decreased at follow-up. This study demonstrates that the percent of hierarchy completed is a better predictor of outcome than treatment change and suggests that 60% or more hierarchy completed is the best statistical predictor of outcome. Depending on cross-validation with another sample, this study begins to offer measurable treatment goals for patients, families, clinicians and insurance companies. This study also shows that quality of life does improve with treatment, but suggests additional treatment interventions are necessary for further improvement in quality of life.



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