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Exposure and response prevention may be superior method of CBT for OCD

Exposure and response prevention, a form of cognitive behavioral therapy for obsessive-compulsive disorder, has accumulated the strongest evidence base thus far, according to Michael G. Wheaton, PhD, of Columbia University, and colleagues.

Several clinical trials comparing CBT consisting of exposure and response prevention (EX/RP) with cognitive therapy have shown the two treatments have similar efficacy, however, recent re-analysis suggested EX/RP had significantly better outcomes than cognitive therapy alone, Wheaton and colleagues reported in Psychiatric Annals.

Randomized controlled trials have found EX/RP to be superior to several other treatments, including progressive muscle relaxation, anxiety management training, fluvoxamine and clomipramine.

“Meta-analyses of EX/RP treatment trials have found large pre- and post-treatment effect sizes, ranging from 1.12 to 1.39,” according to Wheaton and colleagues.

EX/RP requires both the patient and therapist to build an exposure hierarchy, establish a treatment plan and conduct exposure sessions both in the office and at home. The patient and therapist dedicate a substantial amount of time to EX/RP treatment.

Despite significant evidence of the efficacy of EX/RP, not all patients benefit from the treatment, according to Wheaton and colleagues.

A number of studies have found 25% to 30% of patients who begin EX/RP eventually discontinue and of those who complete treatment, up to 24% do not respond.

Another limitation is that well-trained EX/RP therapists are not widely available, according to Wheaton and colleagues, though several studies have explored using technology to combat this.

Results from a randomized controlled trial that compared online EX/RP with online supportive therapy among 100 patients with OCD indicated online EX/RP was more effective, and 60% of patients had clinically significant improvements.

“Consistent research suggests that with skilled therapists and ideal conditions, more than 75% of patients respond to EX/RP, and up to 40% achieve minimal symptoms. What is less clear is why some patients achieve excellent outcomes and others do not,” Wheaton and colleagues wrote. “The field has a pressing need to be able to identify who will be helped by EX/RP and who may need an alternative treatment. In addition, although the efficacy of EX/RP has been established for some time, the exact mechanism through which EX/RP works remains to be discovered.” – by Amanda Oldt

Disclosure: Wheaton reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.