Patient Utilization of Cognitive-Behavioral Therapy for OCD

Abstract

The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate “dose” of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.

No Talking, Just Writing! Efficacy of an Internet-Based Cognitive Behavioral Therapy with Exposure and Response Prevention in Obsessive Compulsive Disorder

“…The low dropout rate of 12% (all of them in the WLCG) demonstrates the high acceptance of the program. The dropout rate is comparable or even lower than those of traditional face-to-face treatments [10,11]. Besides the intense therapeutic interaction, the specific selection criteria might provide an explanation not only for the surprisingly low number of participants fulfilling inclusion criteria and finally entering the study, but also for the low dropout rate.…”

“…Response rates between 63 and 90% were reported [9]. However, about 30% of patients drop out of the treatment prematurely [10,11]. Pre-post effect sizes, compared to a control group, range from d = 0.281 to d = 1.590 with a mean effect size of d = 0.998 [12].…”

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

“…It has been suggested that poor engagement with ERP might explain disappointing recovery rates. Indeed, a naturalistic study found that 25% of adults with OCD refused CBT despite professional recommendation (Mancebo, Eisen, Sibrava, Dyck, & Rasmussen, 2011) whilst Öst et al, Öst et al (2015) reported a 19.1% dropout rate for ERP. Even when people complete a course of ERP, task engagement may be insufficient to achieve recovery.…”

Versorgung Zwangserkrankter mit kognitiver Verhaltenstherapie als Behandlungsmethode erster Wahl

“…Studien aus den USA [Freiheit et al, 2004;Mancebo et al, 2011;Marques et al, 2010] [Goodman et al, 1989]. Das Interview zur Fremdeinschätzung und die Skala zur Selbsteinschätzung weisen eine sehr hohe Korrelation miteinander auf und können als gleichwertig bezüglich der Messung des Schweregrades angesehen werden [Schaible et al, 2001].…”

“…Darüber hinaus wird vermutet, dass manche der Therapeuten, die Zwangspatienten mit KVT behandeln, keine EX/RM durchführen [Hillebrand und Niedermeier, 2014], oftmals aufgrund von Schwierigkeiten der Therapeuten in der Integration von Expositionsbehandlungen in den Routinealltag einer psychologischen Bestellpraxis sowie aufgrund finanzieller Einbußen (z.B. aufgrund unzureichend honorierter Fahrtzeiten zu den Expositionsbehandlungen) [Hillebrand und Niedermeier, 2014;Külz et al, 2010] [Mancebo et al, 2011;Marques et al, 2010]. Die vorliegende Studie weist einige Limitationen auf.…”