Of the 11 patients with articulated feared consequences in the
Foa and others study, 5 showed poor insight into the irrationality
of their obsessional fears (39). A comparison of outcome
indicated that these individuals showed a poorer
response to ERP, relative to patients who showed good insight
that their obsessional fears were senseless. To explain this
finding, Foa and others speculated that patients with poor
insight have difficulty learning information that is inconsistent
with their OCD beliefs. Alternatively, because of their
extreme fear, these patients may not adhere to ERP instructions
as closely as do patients with better insight. The findings
from this small study highlight the importance of assessing
OCD patients' degree of insight into the senselessness of their
symptoms. Although more studies with larger samples are
necessary, insight is likely an important prognostic indicator
of response to ERP.