Cognitive-Behavioral Therapy for Medication Nonresponders With Obsessive-Compulsive Disorder

TLDR

Cognitive‑behavioral therapy is recommended for OCD patients who fail medication, yet few studies have examined its efficacy in medication non‑responders. The study enrolled 20 adults with DSM‑IV OCD who had inadequate response to multiple medications, and after a one‑month wait‑list they received 15 outpatient CBT sessions of exposure and ritual prevention. OCD severity fell significantly, with 53 % of completers achieving clinically significant improvement at posttreatment and 40 % at six months, though poor insight and low effort predicted less benefit and outcomes were less robust than in prior trials.

Abstract

Article AbstractBackground: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. Method: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. Results: OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p < .05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p < .05) predicted degree of improvement. Conclusion: CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.