Effectiveness of Cognitive Retraining with Exposure Response Prevention in Adults with Obsessive–Compulsive Disorder

A BSTRACT Background: Cognitive Behavior Therapy with Exposure Response Prevention (CBT-ERP) is the gold standard treatment for Obsessive–Compulsive Disorder (OCD); however, a significant proportion of individuals experience residual symptoms. Cognitive Retraining (CRT) may address cognitive flexibility impairments that maintain OCD symptoms. Objectives: To examine the efficacy of combining CRT with CBT-ERP compared to CBT-ERP alone for treating OCD with comorbid depression and anxiety in adults. Methods: A parallel-group study with 30 adults (aged 25–35 years) diagnosed with OCD and comorbid anxiety and depression. Participants were randomly assigned to receive either CBT-ERP with CRT (experimental group, n = 15) or CBT-ERP alone (control group, n = 15). Both groups received six weekly sessions. The experimental group additionally received 30-minute CRT sessions prior to 50-minute CBT-ERP sessions. Primary outcomes were assessed using the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Beck Depression Inventory-II, and State-Trait Anxiety Inventory at baseline and post-treatment. Results: The experimental group receiving CRT with CBT-ERP demonstrated significantly greater improvement in OCD severity (Y-BOCS: mean change = 12.20, P < 0.01; Cohen’s d = 3.35) compared to the control group (mean change = 4.60; Cohen’s d = 0.18). Both groups showed significant improvements in depression and anxiety; however, the experimental group exhibited larger effect sizes for OCD reduction, indicating clinically meaningful improvement. Conclusions: Integrating CRT with CBT-ERP produces superior treatment outcomes for OCD, particularly in reducing core obsessive–compulsive symptoms. This combined approach offers a feasible and effective enhancement to standard treatment in resource-limited settings.