An expert consensus panel has recently produced a set of guidelines for the treatment of Obsessive-Compulsive Disorder (Journal of Clinical Psychiatry, 1997, 58, supplement 4). 79 leading experts in the treatment of OCD were surveyed regarding their opinions about 53 clinical situations and the responses were analyzed to produce state-of-the-art guidelines for clinicians to use in real-life clinical practice.
Highlights from the guidelines include:
Selecting initial treatment strategy:
- Pre-pubescent children - CBT* first for both milder and more severe OCD
- Adolescents - CBT first for milder OCD; CBT+SRI** for more severe OCD
- Adults - CBT first for milder OCD; CBT+SRI or SRI alone first for more severe OCD
* CBT = cognitive-behavioral therapy
** SRI = serotonin reuptake inhibitor
Considerations Based on Overall Efficacy, Speed, and Durability of Treatment:
- Milder OCD: CBT alone; or CBT+SRI
- More severe OCD; CBT+SRI or SRI alone
Considerations Based on Tolerability and Patient Acceptability:
- Milder OCD: CBT alone or CBT+SRI
- More severe OCD:CBT+SRI; or SRI alone
Selecting CBT Strategy
Obsessions and Compulsions
- Exposure and Response-Prevention
- Exposure and Response-Prevention + Cognitive Therapy***
(*** What they mean is Exposure and Response-prevention plus cognitive restructuring. ERP is an essential part of CT with OCD.)
Intensity of CBT
Intensity of CBT
- Gradual (i.e. weekly): recommended for most patients (usually 13-20 sessions)
- Intensive (i.e. daily): recommended when speed is of the essence or for patients who have not responded to gradual CBT or who have extremely severe symptoms
The treatment guidelines go into considerable detail, cover a wide range of practical issues which arise in practice, and include educational material for clients and their families. They appear to be consistent with the empirical literature and with our clinical experience (with hundreds of OCD patients). I think practitioners will find them quite useful.
Copies of the guidelines are available from the Obsessive-Compulsive Foundation or from Expert Knowledge Systems ( http://www.psychguides.com ).
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