Researchers first to test therapy next to drug treatment.

Patients with Obsessive-Compulsive Disorder (OCD) can improve their symptoms significantly by adding exposure and response prevention therapy to their treatment regimen when common drug treatment options have failed, according to new research from psychiatrists at the Perelman School of Medicine at the University of Pennsylvania. Exposure and response prevention therapy is a type of cognitive behavior therapy in which the patient is asked to confront triggers that give rise to their obsessions in order to refrain from performing the rituals in response to these obsessions. The study is published in the Journal of Clinical Psychiatry.

OCD is marked by the performing of “rituals” to decrease distress related to one’s obsessions—such as excessive hand-washing to cope with a fixation on hand hygiene, for example.

“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 Penn. “But this study showed that EX/RP is also effective for OCD sufferers who do not benefit sufficiently from common drug treatments for OCD.”

A previous study compared the effects of adding risperidone, pill placebo, and up to 17 twice-weekly therapist-led sessions of EX/RP to medication for OCD. “We found compared to patients who received medication or placebo, those who received EX/RP 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,” McLean said.

The current study included 32 patients who crossed over to receive 17 weeks of EX/RP treatment after not benefitting sufficiently from risperidone. Evaluation at 12 and 16 weeks showed significant symptom improvement, with 25 (78 percent) of patients completing treatment; 17 (53 percent) of them were classified as treatment responders and 11 (34 percent) classified as excellent responders at a 32-week follow-up evaluation. The remaining patients required medication changes during the follow-up period, which enabled them to shift to excellent-responder status.

This study adds to the large body of research that shows the benefits of exposure therapy for patients with OCD. “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 Penn and the creator of exposure therapy. “The therapy can be life-saving, if patients are aware of it.”

About this neuroscience research

Additional Penn authors include Laurie J. Zandberg, PsyD; and Joseph K. Carpenter, BA.

Funding: This research was supported by the National Institute of Mental Health (R01 MH45404) and (R01 MH045436).

Source: Lee-Ann Donegan – University of Pennsylvania

Image Source: The image is credited to Lars Klintwall Malmqvist and is in the public domain

Original Research: Abstract for “Exposure and Response Prevention Helps Adults With Obsessive-Compulsive Disorder Who Do Not Respond to Pharmacological Augmentation Strategies” by Carmen P. McLean, PhD; Laurie J. Zandberg, PsyD; Page E. Van Meter, PhD; Joseph K. Carpenter, BA; Helen Blair Simpson, MD, PhD; and Edna B. Foa, PhD in Journal of Clinical Psychiatry. Published online November 2015 doi:10.4088/JCP.14m09513

Abstract

Exposure and Response Prevention Helps Adults With Obsessive-Compulsive Disorder Who Do Not Respond to Pharmacological Augmentation Strategies

Objective: Serotonin reuptake inhibitors (SRIs) are a first-line treatment for obsessive-compulsive disorder (OCD). Yet, most patients with OCD who are taking SRIs do not show excellent response. Recent studies show that augmenting SRIs with risperidone benefits a minority of patients. We evaluated the effectiveness of exposure and response prevention (EX/RP) among nonresponders to SRI augmentation with 8 weeks of risperidone or placebo.

Method: The study was conducted from January 2007 to August 2012. Nonresponders to SRI augmentation with risperidone or pill placebo (N = 32) in a randomized controlled trial for adults meeting DSM-IV-TR criteria for OCD were offered up to 17 twice-weekly EX/RP sessions. Independent evaluators, blind to treatment, evaluated patients at crossover baseline (week 8), midway through crossover treatment (week 12), post-EX/RP treatment (week 16), and follow-up (weeks 20, 24, 28, and 32). The primary outcome was OCD severity, measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Secondary outcomes were depression, quality of life, insight, and social functioning.

Results: Between crossover baseline and follow-up, nonresponders to SRI augmentation with risperidone or placebo who received EX/RP showed significant reductions in OCD symptoms and depression, as well as significant increases in insight, quality of life, and social functioning (all P < .001).

Conclusions: Exposure and response prevention is an effective treatment for patients who have failed to respond to SRI augmentation with risperidone or placebo. This study adds to the body of evidence supporting the use of EX/RP with patients who continue to report clinically significant OCD symptoms after multiple pharmacologic trials.

Trial Registration: ClinicalTrials.gov Identifier: NCT00389493

“Exposure and Response Prevention Helps Adults With Obsessive-Compulsive Disorder Who Do Not Respond to Pharmacological Augmentation Strategies” by Carmen P. McLean, PhD; Laurie J. Zandberg, PsyD; Page E. Van Meter, PhD; Joseph K. Carpenter, BA; Helen Blair Simpson, MD, PhD; and Edna B. Foa, PhD in Journal of Clinical Psychiatry. Published online November 2015 doi:10.4088/JCP.14m09513

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