Positive affect and imaginal exposure processes in patients with taboo obsessions

Abstract Taboo OCD is associated with less symptom reduction following exposure treatment, compared to response rates for those with other OCD dimensions. To enhance treatment response for those with taboo OCD, researchers must identify novel ways to augment exposure. In line with the Broaden-and-Build theory, heightened positive affect prior to an exposure may facilitate more adaptive cognitive processes and approach motivation; therefore, we hypothesized that greater state positive affect prior to an exposure would be associated with greater perceived efficacy of the intervention, more adaptive exposure performance, and learning that obsessions are not dangerous. In this study, individuals with taboo OCD symptoms repeatedly approached an idiographic obsession through an imaginal exposure. After accounting for comorbid depression, positive affect was positively and significantly associated with perceived efficacy and exposure engagement; however, positive affect was not associated with habituation or learning. Notably, the relationship between positive affect and the perceived effectiveness of, and ability to engage in, a personalized exposure highlights important areas for future research aiming to improve clinical interventions for OCD. To address the study's primary limitation – one-session exposure – researchers should recruit a larger sample and examine how positive affect influences exposure processes over a full treatment.