Psychological Approaches for OCD

The role of a psychodynamic approach inOCDis limited, whereas modern interventions like cognitive and behavioral therapy show promising results . Behavioral therapy (BT) is as effective as pharmacotherapy in OCD (Van Balkom et al., 1998), and some data indicate that the beneficial effects are longer-lasting with behavior therapy . About two-thirds of patients with moderately severe rituals can be expected to improve substantially, but not completely.A combination of BT and pharmacotherapy might constitute the optimal treatment for OCD. Two recent neuroimaging studies found that patients with OCD who are successfully treated with BT show changes in cerebral metabolism similar to those produced by successful treatment with SRIs . BT can be conducted in inpatient and outpatient settings.

The principal behavioral approaches in OCD are exposure for obsessions and response prevention for rituals. Desensitization, thought stopping, flooding, implosion therapy, and aversion conditioning have also been used with OCD patients. In BT the patient must collaborate and carry out assignments. In a study with 18 OCD patients, patients receiving exposure and response prevention showed significant improvement, whereas patients on a general anxiety management intervention (control) showed no improvement from baseline . Direct comparisons of BT and pharmacotherapy are few and are limited by methodological issues. However, reported equal efficacy in a meta-analysis.

Despite the fact that biological interventions are more efficacious for OCD patients, psychodynamic factors might be of considerable benefit in understanding what precipitates exacerbations of the disorder and in treating various forms of resistance to treatment, such as noncompliance to medications or to homework assignments. Symptoms may hold important psychological meanings that make patients reluctant to give them up. Therefore, a psychological assessment of the patient’s resistance to treatment may improve compliance. In the absence of controlled studies of insight-oriented psychotherapy for OCD, the anecdotal reports reporting lasting change do not enable a generalization of its efficacy. Also, the efficacy of medications in producing rapid improvement has rendered slow and long-term psychotherapy out of favor.

Non-specific approaches, such as supportive psychotherapy, have a place in OCD and may help patients improve their functioning and adjustment. Management should also include attention to family members through the provision of emotional support, reassurance, education, and advice on how to cope with and respond to the patient. Family therapy may reduce marital discord and build a treatment alliance, also to help in the resistance to compulsions. Group therapy is useful for providing a support system for some patients.

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