Interpersonal Emotion Dynamics in OCD: Associations With Symptom Severity, Accommodation, & Treatment Outcome

Interpersonal emotion dynamics refer to how partners regulate their own emotions and influence each other’s emotions moment-to-moment during interactions. This includes both intrapersonal regulation (how one calms their own emotions) and interpersonal impacts (how one partner’s emotional expressions affect the other partner).

Fischer, M. S., Baucom, D. H., Abramowitz, J. S., & Baucom, B. R. W. (2023). Interpersonal emotion dynamics in obsessive–compulsive disorder: Associations with symptom severity, accommodation, and treatment outcome. Couple and Family Psychology: Research and Practice, 12(4), 278–286. https://doi.org/10.1037/cfp0000218

Key Points

1. The study examined how emotional dynamics between partners in couples where one person has OCD are associated with OCD symptoms, partners’ accommodation of OCD behaviors, and treatment outcomes.
2. Patients’ intrapersonal emotion regulation patterns reflected functional associations between obsessions and compulsions: (i) when obsessions were worse, patients had more trouble settling down emotionally. It took them longer to get back to a calm state; (ii) when compulsions were worse, patients could actually calm down quicker for a short time. Doing compulsions gave temporary relief.
3. Partners showed different patterns: (i) when patients had more compulsions, partners had a harder time emotionally recovering after upsets. Their feelings stayed activated longer; (ii) also, the more patients had compulsions, the less reactive partners were overall to patients’ emotional rollercoasters.
4. Partners’ own emotional responses were most predictive of poor treatment outcomes: partners staying patient through distress instead of jumping to calm themselves seems crucial for exposure therapy to work well. Their ability to tolerate tough emotions allows more symptom relief.

Rationale

Previous research shows that how partners regulate their own and each other’s emotions during interactions can contribute to the maintenance of disorders like OCD (Fischer et al., 2017).

Family accommodation is also known to maintain OCD symptoms (Boeding et al., 2013). This study aimed to expand past work by examining associations of emotion dynamics with accommodation and treatment outcomes.

The researchers hypothesized that:

1. More severe OCD symptoms would be linked to poorer intrapersonal and interpersonal emotion regulation for both partners, based on past work (Fischer et al., 2017).
2. Partners who were more reactive to patients’ emotional arousal would accommodate more OCD symptoms, extending past findings in binge eating disorder (Weber et al., 2019).
3. Poorer regulatory capacities for both partners at pre-treatment would predict smaller OCD symptom reductions after couple-based CBT.

Method

• The sample included 18 heterosexual couples where the patient had OCD.
• Couples engaged in a 7-minute recorded discussion of a moderately distressing OCD-related topic.
• Emotional arousal was quantified by fundamental frequency (vocal pitch), an established indicator of arousal.
• Self-report measures assessed OCD severity, obsessive and compulsive symptoms separately, and partners’ accommodation.
• 13 couples completed a 16-session couple-based CBT intervention. OCD symptoms and accommodation were re-assessed after treatment.
• Actor-partner interdependence models analyzed intrapersonal emotion regulation and reactivity to the partner’s emotions as predictors of symptoms, accommodation, and treatment outcomes.

Sample

• 18 couples (17 female patients) where one partner had OCD.
• Average age 32-35 years old.
• Mostly white.
• Together, at least 1 year.
• Relatively satisfied relationships.

Statistical Analysis

• Change-as-outcome repeated measures actor-partner interdependence models
• Predictor variables:
  • Intrapersonal regulation (actor effect): return to emotional baseline after perturbation
  • Reactivity (partner effect): the degree one partner’s arousal influences the other’s regulation
• Moderators:
  • OCD severity
  • Accommodation
  • Treatment outcome

Results

Are interpersonal emotion dynamics associated with OCD symptoms?

For patients:

• When obsessions were worse, patients had a harder time calming down. It took longer to settle their emotions.
• When compulsions were worse, patients were able to calm down faster emotionally. Doing compulsions briefly eased their tension.

For partners:

• When patients performed more compulsions, partners had a harder time calming down. Their emotions stayed stirred up longer.
• Also, the more patients performed compulsions, the less partners reacted to patients’ emotional ups and downs overall.

Are interpersonal emotion dynamics associated with partners’ accommodation of OCD behaviors?

• The study found no significant associations between emotion dynamics at pre-treatment and levels of partners’ accommodation. [No hypothesis was supported here.]
• There was no relationship found between how reactive partners were to patients’ emotions before treatment and how much partners were accommodating OCD symptoms at that time.

Are interpersonal emotion dynamics associated with treatment outcomes following couple-based CBT?

• Partners’ faster emotion regulation back to baseline before treatment predicted smaller reductions in both OCD symptoms and accommodation levels after completion of CBT.
• Partners’ greater emotional reactivity to patients’ arousal before treatment also predicted smaller decreases in OCD symptoms and accommodation across treatment.

Insight

Partners having good distress tolerance seems really important for patients to get better with couple-based exposure therapy. Patients did better when partners could stay calm and supportive through the anxious exposures.

A key insight is that compulsions, while temporarily regulating for patients, are dysregulating for partners – slowing their regulation and reducing reactivity.

Partners struggle to tolerate the ongoing distress of exposures if they have poorer regulatory capacities themselves. Faster regulation for partners may indicate escape or avoidance rather than truly effective regulation.

Assessing and addressing partners’ independent distress regulation abilities may improve accommodation and OCD treatment outcomes.

Strengths

• Used an objective behavioral indicator of emotional arousal based on vocal acoustics.
• Examined emotion dynamics at a fine-grained temporal level using APIM.
• Included ratings of obsession and compulsion symptoms separately.
• Directly assessed accommodation by partners.
• Looked at predictors of treatment outcomes.

Limitations

• Small sample size limits generalizability.
• Sample was predominantly white and heterosexual.
• Only 13 couples completed treatment.
• Directionality of effects cannot be determined conclusively in the correlational design.

Implications

The findings from this study suggest that assessing and addressing partners’ emotion regulation skills and distress tolerance could significantly improve outcomes in couple-based treatment for OCD.

Specifically, clinical psychologists who implement exposure and response prevention techniques with couples should evaluate how well partners are able to regulate their own distress independently.

Partners who show quicker returns to emotional baseline or high reactivity to patients’ arousal may lack critical coping and tolerance abilities needed to support OCD treatment fully. These partners may be more likely to revert to symptom accommodation or drop out of therapy when exposures evoke intense anxiety in patients.

Therefore, clinical psychologists may want to provide additional coaching in foundational emotion regulation techniques – such as mindfulness, distraction, and self-soothing – to help equip partners to remain calm and present during difficult exposures.

Building partners’ distress tolerance and regulation capacities directly could strengthen their ability to refrain from accommodation, bolster motivation to progress through anxiety-provoking steps of exposure therapy, and reduce relapse risks after treatment termination.

Conducting further research on real-time interpersonal emotion dynamics using observational methodologies can inform how clinical psychologists can best assess emotional processes in couples with OCD and tailor interventions accordingly.

References

Primary reference

Fischer, M. S., Baucom, D. H., Abramowitz, J. S., & Baucom, B. R. W. (2023). Interpersonal emotion dynamics in obsessive–compulsive disorder: Associations with symptom severity, accommodation, and treatment outcome. Couple and Family Psychology: Research and Practice, 12(4), 278–286. https://doi.org/10.1037/cfp0000218

Other references

Boeding, S. E., Paprocki, C. M., Baucom, D. H., Abramowitz, J. S., Wheaton, M. G., Fabricant, L. E., & Fischer, M. S. (2013). Let me check that for you: Symptom accommodation in romantic partners of adults with obsessive–compulsive disorder. Behaviour Research and Therapy, 51(6), 316-322. https://doi.org/10.1016/j.brat.2013.03.002

Fischer, M. S., Baucom, D. H., Baucom, B. R., Abramowitz, J. S., Kirby, J. S., & Bulik, C. M. (2017). Disorder-specific patterns of emotion coregulation in couples: Comparing obsessive compulsive disorder and anorexia nervosa. Journal of Family Psychology, 31(3), 304. https://doi.org/10.1037/fam0000251

Weber, D. M., Fischer, M. S., Baucom, D. H., Baucom, B. R. W., Kirby, J. S., Runfola, C. D., Matherne, C. E., & Bulik, C. M. (2019). The association between symptom accommodation and emotional coregulation in couples with binge eating disorder. Family Process, 58(4), 920-935. https://doi.org/10.1111/famp.12391

Keep Learning

Here are some potential Socratic discussion questions about this paper for a college class:

1. How might assessing and addressing family members’ independent emotion regulation skills improve OCD treatment outcomes? What specific skills could be helpful targets?
2. In what other psychological disorders might family members’ regulation capacities influence maintenance or treatment outcomes? How are OCD and disorders like binge eating disorder similar and different in this regard?
3. What future research directions would be informative to better understand the role of emotion dynamics in OCD and accommodation? What methods could be used?
4. How do you think individual versus couple or family therapy for OCD might differ in their focus on interpersonal emotion processes? What are the trade-offs of each approach?
5. Besides distress tolerance skills, what other psychosocial interventions could help support family members struggling with a loved one’s OCD? How might we develop more robust support systems?