On May 8, 2017, Jaya Shapiro asked:
Hi Everyone,
Wondering if exposure with response prevention/CBT plus SSRI's is still the best practice for OCD? Does anyone who specializes in this area have additional input? I was thinking perhaps some of the mindfulness elements of DBT could be helpful as well.
Thanks so much!
Jim Spira:
My take on this is that behavior therapy approaches can be tried initially along with high does SSRI. When that fails to completely extinguished the behaviors, then teaching more skill-based approaches can be useful (such as identifying and tolerating the impulses, through mindfulness or other similar approaches, and then refocusing and engaging in some other activity). If that continues to fail, then looking at more dynamic issues as well as secondary gains is helpful. Personally, I approach OCD with this three-pronged approach right from the beginning. Dirk Elting:
Hi all,
I haven't done this work in a while, but I've always been of the view that exposure plus response prevention was the treatment of choice, adding meds was of minimal benefit and might even reduce effectiveness of the exposure based treatment. The abstract from a 2015 paper in Clinical Psychology Review by Ost et al didn't completely support my understanding about meds, but I wasn't too far off. ;-).
Obsessive–compulsive disorder is ranked by the WHO as among the 10 most debilitating disorders and tends to be chronic without adequate treatment. The only psychological treatment that has been found effective is cognitive behavior therapy (CBT). This meta-analysis includes all RCTs (N = 37) of CBT for OCD using the interview-based Yale–Brown Obsessive Compulsive Scale, published 1993 to 2014. The effect sizes for comparisons of CBT with waiting-list (1.31), and placebo conditions (1.33) were very large, whereas those for comparisons between individual and group treatment (0.17), and exposure and response prevention vs. cognitive therapy (0.07) were small and non-significant. CBT was significantly better than antidepressant medication (0.55), but the combination of CBT and medication was not significantly better than CBT plus placebo (0.25). The RCTs have a number of methodological problems and recommendations for improving the methodological rigor are discussed as well as clinical implications of the findings.
The link to the whole paper can be found at:http://commonweb.unifr.ch/artsdean/pub/gestens/f/as/files/4660/45946_091441.pdf The review is excellent, at least in my view.Tyler Ralston:
Aloha Jaya,
I regularly treat OCD in my practice.
Related to your question, adding CBT to meds can lead to superior outcomes compared to those who are on meds alone. But interestingly, adding meds to CBT doesn’t usually increase, nor reduce, the efficacy of CBT. In other words, CBT helps those already on meds, but meds don’t necessarily help those already receiving good CBT.
Mindfulness and acceptance based elements are excellent for those struggling with OCD.
Regards,
Tyler
Dr. Kelly Harnick:
Aloha all, with regards to the efficacy of CBT and SSRI's for OCD: Review of the pharmacotherapy meta-analytic research concludes that in the tx of OCD, combination therapy (CBT and SSRI) shows no greater efficacy over single modality behavioral therapy when symptoms are primarily compulsive, whereas combination therapy (CBT and SSRI) shows greater efficacy when symptoms are primarily obsessive. Pharmacotherapy alone shows some efficacy, however, adding CBT shows the greatest efficacy overall as was stated previously on this chain. Hope this helps.
