CBT to Treat OCD May Not Be Enough for Some Patients

Teens with the contamination variant of obsessive compulsive disorder (OCD) are not generally more ill than young people with other forms of disabling obsessive thoughts and compulsive behavior.

But a new Danish study finds that if teens with contamination OCD have poor insight into their condition, they may find it more difficult to recover and become healthy again with 14-week cognitive behavioral therapy (CBT), the standard form of treatment in Denmark for OCD.

“The research project shows that in the longer term, some of the patients who initially appear to react positively to cognitive behavioral therapy unfortunately turn out not to have received the help that they need. This is particularly true of young people with cleanliness rituals and reduced insight into their condition,” said Ph.D. student Sanne Jensen from Aarhus University in Denmark.

“The tricky thing is that they initially react positively to the cognitive behavioral therapy, and they therefore leave the mental health services again after the 14-week period of treatment. But when we contact them again after three years, we can see they demonstrate a worrying development — they have gotten worse.”

The findings are published in the Journal of Child Psychology and Psychiatry.

Jensen and the study’s senior researcher, Professor Per Hove Thomsen, emphasize that the results do not in any way undermine the value of CBT. CBT allows OCD patients to face their fears and obsessions, while simultaneously gaining a more realistic view of the outside world. Treatment lasts 14 weeks with a possible extension.

“Part of the overall picture is that almost 80 percent of those we studied were so well-functioning following the cognitive behavioral therapy that after three years they no longer had OCD to a degree that required treatment,” says Thomsen.

After the three-year period, researchers measured the same low level of symptoms as they did following the completion of the treatment in no less than 210 out of 269 of the children and adolescents between the ages of 7-17 who participated in the study.

Only 59, or approximately one in five, of the young people were in a worrying situation where there was fear of a relapse after three years.

“We’re fortunate that the study very precisely identifies the group which we should be keeping a close eye on after the end of the treatment, namely teenagers with cleanliness rituals/contamination anxiety and poor insights into their condition,” said Thomsen.

Thomsen said the research results may lead to despondency among particularly vulnerable patients and their relatives.

“The conclusion isn’t that you’re doomed to a life-long disabling OCD if you’re a teenager with cleanliness rituals and poor insights into your condition,” saud Thomsen.

“There are also young people from this patient group who don’t suffer a relapse. On the contrary, the conclusion is that we need to become better at following up on precisely these patients, because otherwise we risk leaving them in the lurch. Perhaps the treatment needs to be repeated, or perhaps there’s a need to supplement the treatment with SSRI medicine.”

Source: Aarhus University