Obsessive-compulsive disorder: treatment and management

Psychology A2 · Clinical Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

SSRIs (selective serotonin reuptake inhibitors) are the main drug treatment. They block the reuptake of serotonin, so more stays in the synapse. Improvement takes several weeks, there can be side effects, and symptoms often return when the drug is stopped.

In exposure and response prevention (ERP) the client faces a feared trigger, step by step, and is stopped from doing the ritual. Anxiety rises, then falls by itself (habituation). CBT adds work on thinking errors, such as inflated responsibility.

The key study, Lovell et al. (2006), tested whether CBT given by telephone is as good as CBT given face to face.

Rules to remember

SSRIs raise serotonin in the synapse; they treat symptoms, not the cause.
ERP = graded exposure to the trigger + no ritual, until anxiety falls (habituation).
Lehmkuhl et al. (2008): case study of a 12-year-old boy with autism and OCD; ERP-based CBT adapted to his needs brought a large fall in symptoms, which lasted at follow-up.
Lovell et al. (2006): randomised controlled non-inferiority trial with 72 adult OCD patients in the UK, randomly allocated to telephone or face-to-face CBT (exposure therapy), 10 weekly sessions.
Lovell measures: Y-BOCS, a depression inventory and client satisfaction, with follow-up to 6 months.
Lovell result: both groups improved; telephone CBT was not inferior, and satisfaction was high in both groups.
Non-inferiority trial = tests whether a new treatment is no worse than the standard one.

Common mistake

Saying Lovell et al. showed telephone CBT is better than face-to-face CBT. The trial only showed it is no worse (equivalent), while using less therapist time and being easier to reach.

Worked example

A clinic in a rural area has one OCD therapist and patients who live far away. Use Lovell et al. (2006) to advise the clinic.

Lovell et al. randomly allocated OCD patients to telephone or face-to-face CBT.
Y-BOCS scores fell by a similar amount in both groups, and the gain was kept at follow-up.
Patients were as satisfied with telephone therapy as with face-to-face therapy.
The sample was from one country, so attitudes to phone therapy may differ elsewhere.

Answer: Telephone CBT is a reasonable choice: it is likely to work as well as face-to-face CBT and removes travel, but the clinic should check that its own patients accept it.

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