Key Takeaways

From the Authors As published in the article
  1. Concurrent delivery of exposure and response prevention (ERP) for OCD and prolonged exposure (PE) for PTSD via video therapy is associated with significant symptom improvement in both conditions.
  2. Patients with comorbid OCD and PTSD may require extended treatment beyond standard protocols; among those who continued past 40 sessions, response rates continued to improve.
  3. Therapists trained in both ERP and PE can feasibly alternate between these approaches within a single treatment episode, addressing both conditions without requiring sequential or separate courses of therapy.
Extended Takeaways
  1. In this naturalistic cohort of 181 adults, median treatment intensity was 1.1 sessions per week (IQR: 0.9–1.3; ≈4–6 per month) over 34.6 weeks (IQR: 21.7–48.4), suggesting concurrent exposure-based care for obsessive-compulsive disorder and posttraumatic stress disorder can be delivered at a standard outpatient pace rather than an intensive schedule.
  2. Symptom change was already detectable by session 20: PCL-5 scores fell from 43.5 (SD = 14.2) to 35.0 (SD = 15.4) and DOCS scores from 35.2 (SD = 13.7) to 24.5 (SD = 14.4), with Hedges g = 0.56 for PTSD and Hedges g = 0.77 for OCD.
  3. By the final session, treatment gains were substantial across both disorders, with PCL-5 improving by -17.1 points, 39.3%; Hedges g=1.03, 95% CI: 0.85–1.21 and DOCS improving by -15.7 points, 44.7%; Hedges g=1.16, 95% CI: 0.97–1.35.
  4. Patients who ultimately achieved and maintained response tended to improve in obsessive-compulsive disorder before posttraumatic stress disorder, with median time to first response of 11 sessions (IQR: 8–19) for OCD versus 15 sessions (IQR: 8–23) for PTSD; dual response emerged at a median of 20 sessions (IQR: 13–27).
  5. Secondary benefits extended beyond core symptoms: DASS-21 Depression decreased from M=17.6 (SD= 10.4) to mean=12.3 (SD=10.6), WHODAS 2.0 from mean=26.8 (SD=7.8) to mean=22.1 (SD=8.6), and Q-LES-Q-SF increased from mean =50.5 (SD=14.2) to mean=59.9 (SD=16.9), all adjusted P < .001.
  6. Baseline psychiatric medication use did not significantly moderate OCD or PTSD outcomes, which suggests concurrent ERP and PE may remain beneficial whether or not patients are taking medication at treatment entry.
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