Getting Exposure for OCD

Exposure and response prevention therapy helped obsessive-compulsive disorder patients when drugs failed


When drugs don't work, how is a patient with obsessive-compulsive disorder (OCD) supposed to manage?

There's at least one option in exposure and response prevention therapy, a new study found. When common drugs used to treat OCD didn't work, patients in this study saw improvements when they underwent this therapy.

“We know that exposure and response prevention therapy (EX/RP) can benefit these patients,” said lead study author Carmen McLean, PhD, assistant professor of clinical psychology at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, in a press release. “But this study showed that EX/RP is also effective for OCD sufferers who do not benefit sufficiently from common drug treatments for OCD.”

OCD is a disorder marked by a compulsive need to repeat actions or rituals many times over. While OCD has become a half-joking self-description for some people who are very cleanly or focused on a particular topic, true OCD causes extreme distress for the patient and affects daily life.

Many of the 2.2 million OCD patients in the US receive therapy, drugs or a combination of the two, according to the National Institute of Mental Health (NIMH). But some patients do not respond to common OCD drugs, such as risperidone (brand name Risperdal). This study is the first to look at the effects of EX/RP in those patients.

In EX/RP, a therapist asks the patient to face certain triggers head-on. A patient who is preoccupied with hygiene could be asked to touch the handle of a public door, for instance, and then not be allowed to wash her hands for a specified amount of time. The belief is that, over time, the patient begins to see that her compulsive habits don't actually prevent any certain outcome, reducing the anxiety tied to completing or not completing that action.

For their study, Dr. McLean and colleagues studied 32 OCD patients who had not seen benefit from taking risperidone. These patients underwent EX/RP for 17 weeks. At various follow-up periods, the majority of these patients showed big improvements in their OCD symptoms, with 87 percent responding to the treatment at a 32-week endpoint.

“We want patients to know that there is another option, if common drug treatments have failed them,” said senior study author Edna Foa, PhD, director of the Center for the Treatment and Study of Anxiety and the creator of prolonged exposure therapy, in a press release. “The therapy can be life-saving, if patients are aware of it.”

This study was published Nov. 11 in the Journal of Clinical Psychiatry.

The NIMH funded this research. Conflict of interest disclosures were not available at the time of publication.