Exposure Therapy Successful in Adults with OCD

December 23, 2015
MD Magazine® Staff

Exposure and response prevention appears to be an effective treatment for patients with obsessive-compulsive disorder who have failed to respond to serotonin reuptake inhibitor augmentation with risperidone or placebo.

Researchers at the Perelman School of Medicine at the University of Pennsylvania suggest that exposure and response prevention appears to be an effective treatment for patients with obsessive-compulsive disorder (OCD) who have failed to respond to serotonin reuptake inhibitor (SRI) augmentation with risperidone or placebo. The novel cognitive behavior therapy involves asking patients to confront triggers of their obsession and teaches them to refrain from performing their normal rituals in response to these obsessions.

Although SRIs are a first-line treatment for OCD, most patients with the disorder who are taking SRIs do no experience an excellent response, write the study authors in the Journal of Clinical Psychiatry. With previous studies showing that augmenting SRIs with risperidone benefits only a minority of patients, the researchers conducted an evaluation of the effectiveness of exposure and response prevention among non-responders to SRI augmentation with 8 weeks of risperidone or placebo.

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

Between January 2007 and August 2012, nonresponders to SRI augmentation with risperidone or placebo in a randomized trial for adults who met DSM-IV-TR criteria for OCD were offered up to 17 twice-weekly exposure and response prevention sessions. “We found compared to patients who received medication or placebo, those who received [exposure and response prevention] 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 eight weeks,” said Dr. McLean.

For the study, evaluators who were blind to treatment evaluated patients at treatment crossover baseline (week 8), midway through crossover treatment (week 12), after exposure and response prevention treatment (week 16), and at 20, 24, 28, and 32 weeks follow-up.

Significant improvements were observed at weeks 12 and 16, with 78% of patients completing treatment, among whom 53% were considered treatment responders and 34% were considered excellent responders at week 32 follow-up. Medication changes required by the remaining patients during the follow-up period enabled them to be considered excellent responders.

“We want patients to know that there is another option, if common drug treatments have failed them,” explained senior author, Edna Foa, PhD, professor of clinical psychology in the department of psychiatry and director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania and the creator of exposure therapy. “The therapy can be life-saving, if patients are aware of it.”