Behavioural Psychotherapy for Obsessive-Compulsive Disorder

Abstract

Behavioural psychotherapy is now widely used for obsessive-compulsive disorder. A growing body of literature suggests the durable effectiveness of behavioural methods for rituals and, to a lesser degree, obsessive thoughts. In controlled studies rituals have been treated with exposure and response prevention with success ranging from 50 to 70% of computers. Patients with washing rituals are easier to treat than those with checking rituals, ruminations may persist despite improvement in rituals. The cost-effectiveness of self-exposure homework has been recently stressed. Follow ups ranging from 2 to 6 years show the stability of exposure results. Exposure in vivo compares favorably to antidepressants in non depressed obsessive compulsive disorders. Factors predicting fewer gains have included baseline depression, overvalued or bizarre ideation, severity of rituals, checking rituals, being male and high avoidance. Whether the addition of cognitive methods enhances outcome of checking rituals and rumination remains to be confirmed. Biological changes during exposure are a promising new area of interest.