Emotional clarity and awareness predict obsessive–compulsive disorder symptoms during exposure and response prevention in a naturalistic treatment sample

Obsessive-compulsive disorder (OCD) is associated with “emotional disconnections” (e.g., difficulty understanding your emotions), but very limited work has examined these links prospectively or in the context of OCD treatment. This study tested the hypotheses that emotional clarity and emotional awareness would predict improvement in OCD symptoms during Exposure and Response Prevention (ExRP) in a naturalistic treatment sample, based on the putative impact of these factors on emotional processing. We tested the effect of baseline levels of emotional clarity and awareness (measured using the Difficulties in Emotion Regulation Scale) on OCD symptoms at baseline, mid- and post-treatment (Obsessive-Compulsive Inventory, Revised) in a study of adults diagnosed with OCD and receiving ExRP in an open treatment clinic (N = 131) using multilevel modeling. Both lack of emotional clarity and lack of emotional awareness predicted OCD symptom severity at post-treatment. Lack of awareness also predicted greater improvement in OCD symptoms during treatment, while clarity did not. Consistent with previous research, individuals who reported being less clear about their emotions had more severe OCD symptoms at post-treatment. Extending previous findings, those who reported being more aware of their emotions before treatment showed less symptom improvement during treatment. Clinical and theoretical implications of these findings are discussed.