Home-Based Cognitive-Behavioral Treatment of Chronic, Refractory Obsessive-Compulsive Disorder Can Be Effective

Abstract

Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.

Can cognitive analytic therapy treat hoarding disorder? An adjudicated hermeneutic single‐case efficacy design evaluation

“…In terms of the possible reasons why the CAT was unsuccessful in treating the HD, then the following are of note: (i) all the sessions were delivered as outpatient psychotherapy, and there is evidence that integrating domiciliary visits (Linkovski et al ) or webcam support (Muroff & Steketee, ) in supporting discard and organization efforts are clinically worthwhile; (ii) the participant had been unresponsive to two previous courses of CBT and so could therefore be considered a treatment refractory case (Rosqvist, Thomas, & Egan, ); and (iii) the common attentional problems in HD also can compromise treatment delivery (Wheaton, ), and this was the case here, in terms of difficulty maintaining focus in sessions. The previous CBT interventions had failed because they did not manage to engage the client in any consistent exposure to discard activities, and this was also the case in the current attempt to deliver CAT.…”

Treatment‐resistant Obsessive‐compulsive Disorder in Young People: Assessment and Treatment Strategies

“…The NICE guidelines recommend home‐based treatment for adults with severe, treatment resistant OCD and there are a number of theoretical reasons why home‐based CBT could improve treatment outcome in such cases: it largely negates the problem of non‐attendance; it reduces the trouble of generalising from the clinic to real‐life settings; and it allows opportunity to tackle rituals that are confined to home settings. In line with these hypotheses, there is some evidence from single case studies and case series that home‐based CBT is an effective treatment for adults with severe, treatment‐refractory OCD (Rosqvist, Thomas, & Egan., 2002; Rosqvist et al, 2001). To date home‐based treatment has not been evaluated in RCTs or among paediatric populations.…”

How resistant is ‘treatment‐resistant’ obsessive‐compulsive disorder in youth?

“…Interpreting treatment-resistance as a technical failure implies that the individual may respond to subsequent attempts at evidence-based treatment. Indeed, a number of case series and naturalistic studies conducted among adults with OCD have found that individuals with a history of non-response to CBT made significant gains (21-49% reduction in OCD symptoms) following specialist CBT that was either community-based (Boschen, Drummond, & Pillay, 2008), home-based (Rosqvist, Thomas, & Egan, 2002;Rosqvist et al, 2001) or delivered in an inpatient setting (Boschen et al, 2008;Drummond, 1993). It is of note that the majority of these studies examined non-standard and arguably more intensive formats of CBT (home-based or inpatient) and only one examined outcomes following community-based CBT (Boschen et al, 2008).…”