Concentrated ERP for Patients With Difficult‐to‐Treat OCD: Insight as a Predictor of Acute and Long‐Term Outcomes

Background Cognitive‐behavioral therapy (CBT) with exposure and response prevention (ERP) is a recommended treatment for obsessive‐compulsive disorder (OCD), although many patients who undergo this regimen do not achieve satisfactory symptom relief, and maintaining long‐term remission is challenging. Concentrated exposure therapy (cET) has emerged as a potential treatment for treatment‐resistant OCD. However, the role of insight as a predictor of treatment outcomes in this context remains underexplored. Methods We conducted a secondary analysis of a randomized controlled trial (RCT) including 163 adults diagnosed with treatment‐resistant OCD. This study used linear regression models to evaluate whether pre‐treatment levels of insight and changes in insight—measured by the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) insight item—were associated with outcomes after 4 days of cET and whether insight levels changed post‐treatment. Results Baseline insight did not predict OCD severity at post‐treatment or 3‐month follow‐up but was associated with greater OCD severity at the 12‐month follow‐up. Insight scores improved significantly from pre‐ to post‐treatment but worsened during the follow‐up period. Notably, a change in insight during cET was a significant predictor of OCD symptom severity at all follow‐up intervals. Conclusions Baseline insight was not a strong predictor of short‐term treatment outcomes following cET but was related to long‐term OCD severity. Improvements in insight during cET were associated with achieving and maintaining reduced symptoms over time. These results suggest that improvements in OCD and enhanced insight are associated. Trial Registration: ClinicalTrials.gov identifier: NCT02656342.