Causal attributions and OCD treatment response: A linguistic analysis of OCD patients' self-reported etiological explanations in intensive residential treatment.

In the present study, 43 obsessive-compulsive disorder (OCD) patients receiving cognitive-behavior therapy (CBT)/exposure and response prevention (ERP) in an intensive residential treatment program responded to an open-ended question about causal attributions (i.e., personal explanations for the etiology of their OCD) at baseline and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at baseline and treatment discharge. Baseline self-reported responses about causal attributions were qualitatively coded to derive predictors (biological/genetic, environmental, psychological, and interactional attributions). Predictors were entered into a binary logistic regression with Y-BOCS responder status (at least partial response [≥25% pre-post reduction] vs. no response) as the outcome. After controlling for length of stay and number of comorbid psychiatric diagnoses, only biological/genetic attributions uniquely predicted increased odds of treatment response, odds ratio = 10.04, p = 0.03. Biological/genetic attributions may reduce self-blame for symptoms or increase expectancy violation likelihood during treatment, thereby improving odds of response. Clinicians should assess OCD patients' causal attributions as part of routine clinical care to hopefully optimize treatment outcomes.