# Exposure and Response Prevention to Improve Functioning in Veterans with Obsessive Compulsive Disorder

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

Project Background
Exposure and Response Prevention (ERP) is the gold standard evidence-based psychotherapy for OCD;
however, few Veterans receive ERP and no randomized controlled trials (RCTs) have been published
examining the effectiveness of ERP among Veterans or in individuals with comorbid OCD and posttraumatic
stress disorder (PTSD). OCD impacts work, social, and family functioning, such that 38% of people with OCD
are unable to work due to the severity of symptoms and 25% attempt suicide at some point in their lives
(Mancebo et al., 2008). It is essential to examine the effectiveness of ERP in Veteran specific trials because
Veterans are a complex, highly comorbid population, and have significant trauma histories which can
complicate ERP treatment. Many Veterans face logistic barriers to accessing therapy including transportation,
distance, childcare, and work, in addition to challenges leaving the home due to OCD symptoms. Video
telehealth (VTH) can increase Veterans’ access to ERP and may enhance the generalizability of exposures
since in-home exposure exercises can focus on OCD triggers that people encounter in their home
environment. This may mean more direct impact to the Veteran’s daily life functioning and quality of life.
Project Objectives
The proposed 4-year multisite RCT will compare outcomes of VTH-delivered ERP to those of a stress
management training control condition among 160 Veterans with OCD. Half of the sample with have comorbid
PTSD. The primary aim will examine whether participants’ functioning, quality of life, and OCD symptoms differ
as a function of the intervention (ERP vs. control). The secondary aim will examine these outcomes among the
half of the sample with comorbid OCD and PTSD. The tertiary aim is to conduct a mixed-methods formative
evaluation of the implementation potential of ERP in VA mental health settings.
Project Methods
Eligible Veteran participants will be randomized to ERP or to the control condition. Veterans randomized to
ERP will receive 16 weekly ERP sessions delivered via VTH. Control participants will receive 16 weekly
sessions of a stress management training intervention delivered via VTH. Participants in both conditions will
complete assessments at post-treatment and 6 months after completing treatment. Participants in the ERP
condition will also complete an assessment of treatment satisfaction and a qualitative exit interview assessing
the Veterans’ perceptions of the impact of treatment on multiple domains of functioning, including the impact
on PTSD symptoms. Providers and VA administrators will participate in qualitative interviews regarding the
implementation potential of ERP in VA.
Contribution to VHA
This work addresses RR&D clinical priorities related to cognitive-behavioral interventions for improving
Veterans’ functioning, participation in society, and quality of life. Establishing ERP as an evidence-based
treatment in the complex Veteran population has the potential to impact the...

## Key facts

- **NIH application ID:** 10854769
- **Project number:** 5I01RX003677-03
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Terri Lynn Fletcher
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-06-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10854769

## Citation

> US National Institutes of Health, RePORTER application 10854769, Exposure and Response Prevention to Improve Functioning in Veterans with Obsessive Compulsive Disorder (5I01RX003677-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10854769. Licensed CC0.

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