Predictors and consequences of accommodation as an interpersonal maintenance factor of obsessive-compulsive disorder in daily life: A multi-method investigation

• Applicants: Professorin Dr. Beate Ditzen; Professorin Melanie Fischer, Ph.D.
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 456142008

Obsessive-compulsive disorder (OCD) is a complex mental disorder characterized by recurring distressing thoughts and compulsions, and is associated with severe distress and impairment. Even the best available treatments result in recovery rates of only 30-60%. Therefore, it is important to study factors that contribute to a chronic course of OCD. One underutilized domain for a fuller understanding of adult OCD is the interpersonal context. Emerging research suggests that partner accommodation (ACC) is a key interpersonal maintenance factor. ACC refers to various ways partners attempt to prevent or alleviate patients’ distress by participating in rituals, enabling avoidance, providing reassurance, and modifying daily routines. Over 88% of family members report engaging in ACC. ACC is theorized to be maintained by its short-term positive consequences (reduction/prevention of distress), even though ACC is associated with more severe OCD. However, this momentary reduction in distress has not been examined empirically and could be reflected in subjective and psychobiological responses. Additionally, it is largely unclear why some partners accommodate more than others. Our preliminary findings suggest that the way partners respond to their own and the patient’s emotions might explain differences in ACC. That is, partners who are more reactive to patients’ momentary vocally encoded arousal might accommodate more when the patient is distressed. Thus, ACC might not only serve to regulate patient distress but also the partner’s. Vocal features that communicate arousal (fundamental frequency) are a deeply rooted biological response to signal distress and are therefore well suited to examine these highly interpersonal processes. We propose a multi-method approach to examine antecedents and consequences of ACC at multiple time scales, also representing the first study of ACC in OCD in daily life. We will recruit N=60 couples (one partner with OCD). Couples will complete a lab-based assessment including an OCD-related conflict task, followed by a 5-day ecological momentary assessment in daily life focused on ACC, OCD symptoms and subjective/psychobiological stress, and a follow-up after 3 months. Assessments include clinical interviews, self-reports, salivary cortisol and alpha-amylase, and vocally encoded emotional arousal. We will examine antecedents of ACC at the micro level during the interaction task (reactivity to vocally encoded emotional arousal, momentary psychobiological stress) and in terms of trait differences in stress responses. Further, we will examine within-day reductions in subjective and psychobiological stress following ACC (short-term consequences) and next-day and 3-month OCD symptom severity (long-term consequences). We will use multilevel-modeling to test all hypotheses. In sum, this paradigm will provide a detailed, ecologically valid picture of ACC, addressing the research gap regarding the interpersonal maintenance of adult OCD.

• DFG Programme: Research Grants