For patients with obsessive-compulsive disorder, taking serotonin reuptake inhibitors is typically the first line of defense, but most patients who take the drugs do not respond well. Now, a new study suggests symptoms can be improved by incorporating exposure and response prevention therapy to the treatment regimen.

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People with OCD have obsessive rituals that they must repeatedly perform, which in turn interfere with daily life and cause distress - such as repetitive cleaning to mitigate stress from obsession with germs.

The study, conducted by psychiatrists at the Perelman School of Medicine at the University of Pennsylvania, is published in the Journal of Clinical Psychiatry.

Obsessive-compulsive disorder (OCD) is characterized by performing "rituals" that ameliorate stress that arises from obsessions. The thoughts and rituals associated with the condition are more than just double-checking that the stove has been turned off; they cause distress and get in the way of daily life.

These obsessions and compulsions are uncontrollable for sufferers. For example, if a person is obsessed with germs, they may repeatedly and unnecessarily wash their hands. Likewise, if a person has an obsession with intruders, he or she may lock and relock the door several times.

Although healthy people have rituals, the difference is that people with OCD perform such rituals despite them interfering with daily life and causing distress.

The condition can be accompanied by eating disorders, anxiety or depression, and treatment typically involves psychotherapy, medication or both.

Because many patients with OCD do not respond well to serotonin reuptake inhibitors (SRIs), the researchers - led by Prof. Carmen McLean, PhD, from the Center for the Treatment and Study of Anxiety at Penn - wanted to investigate exposure and response prevention therapy (EX/RP).

This treatment is a type of cognitive behavior therapy whereby the patient confronts triggers that bring about their obsessions, in an attempt to stop performing the associated rituals.

'We want patients to know there is another option'

In a previous study, the team compared the effects of adding risperidone (an antipsychotic medication), a pill placebo and sessions of EX/RP to medication for patients with OCD.

Fast facts about OCD
  • OCD sometimes runs in families, but no one knows why some people have it while others do not
  • It typically starts during childhood or teen years; most people are diagnosed by age 19
  • OCD affects around 2.2 million adults.

Learn more about OCD

"We found compared to patients who received medication or placebo, those who received EX/RP showed significantly more reductions in OCD symptoms and depression, as well as significantly more increases in insight, quality of life, and social function after only 8 weeks," says McLean.

Their newest study, conducted from January 2007-August 2012, involved 32 patients who previously did not receive any benefit from risperidone and who crossed over to receive 17 weeks of EX/RP treatment.

Results show that after 12 and 16 weeks, the patients showed significant symptom improvement - as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

In detail, 53% of patients were classed as "treatment responders," and 34% were categorized as "excellent responders" at a follow-up evaluation 32 weeks later.

The team notes that the remaining patients needed medication changes during the follow-up period, which eventually changed them to "excellent-responder" status.

Commenting on their findings, senior author Edna Foa, PhD, says:

"We want patients to know that there is another option, if common drug treatments have failed them. The therapy can be life-saving, if patients are aware of it."

The researchers say their research "adds to the body of evidence supporting the use of EX/RP with patients who continue to report clinically significant OCD symptoms after multiple pharmacologic trials."

Medical News Today previously reported on a study that suggested brain scans could predict the effectiveness of treatment for OCD.