An Update on the Cognitive Behavior Therapy of Obsessive Compulsive Disorder in Adults

Article excerpt

Abstract

Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder with an estimated lifetime prevalence in adults of 2-3 %. Our aim is to provide an overview of the development of effective psychological treatments for OCD, together with a systematic literature review of the latest research in the field. An extensive literature search was performed to identify relevant articles in several databases including MEDLINE, PUBMED and PsycINFO, using the following keywords: obsessive-compulsive disorder, cognitive-behavioural therapy, exposure, response prevention, cognitive therapy. Controlled trials have demonstrated that cognitive- behavioral therapy (CBT) is an effective treatment for OCD. CBT is at least as effective as medication and shows good benefits at follow up. Nevertheless, more studies are still needed, mainly focusing on long-term follow-up, group-treatment and the combined use of CBT with SSRIs. A prefrontal cortico-striato-thalamic brain system is involved in the mediation of OCD symptoms. Recent research has demonstrated that CBT for OCD can systematically modify cerebral metabolic activity in this corticosubcortical circuit in a manner which is significantly related to clinical outcome.

Keywords: obsessive-compulsive disorder, cognitive-behavioural therapy, exposure, response prevention, cognitive therapy

Obsessive-compulsive disorder (OCD) is one of the most frequent anxiety disorders, with a lifetime prevalence of 2-3%. OCD is an anxiety disorder characterized by intrusive ideas (obsessions) and repetitive behaviors (compulsions) which produce personal suffering, significantly affect the patient's quality of life or interfere with the daily activities (Jenike, 2001; Kuelz, 2006) and interpersonal relationships.

Among the most frequent obsessions are fear of contamination, pathological doubt, somatic preoccupation, need for symmetry, aggressive or sexual thoughts. Frequent compulsions include repetitive hand washing, repeated checks, repetitive counting, collecting etc. Patients are, in most cases, aware of their unreasonable behavior. In order to fulfill DSM-IV criteria, a patient must have either obsessions or compulsions or both types of symptoms. While obsessions are anxiety-producing, compulsions are anxiolitic.

Until the 60's, the perspective on OCD was pessimistic, being regarded as a chronic disorder, resistant to treatment. This vision was due to the failure of psycho-analytical therapy (Cottraux, Bouvard, & Milliery, 2005). However, in the 60's, two great progresses were made in the OCD therapy, demonstrating for the first time the efficacy of behavior therapy, through exposure and response prevention (Victor Meyer in 1966) and the efficiency of clomipramine in the treatment of OCD symptoms (in Spain, by Juan Jose Lopez - Ibor in 1968).

OCD is the mental disorder, with probably, the most progresses in the last 20 years regarding psycho-pharmaceutical and psycho-therapeutic treatment. For a long time, OCD has been regarded as the window towards unconscious functioning, being attributed to unconscious conflicts. Today, OCD is seen as a good example of a neuropsychiatric disorder, mediated by dysfunctions in some specific neuronal circuits, accessible by specific psychopharmaceutical and psychotherapeutic means. As a result of a number of functional neuroimaging studies, it has been concluded that OCD symptoms appear mainly as a result of hyperactivity in the orbito-fronto-subcortical circuit (caudate nucleus and thalamus) (Ardelean, & Suciu, 2006). Further studies are needed to establish the nature and origin of this dysfunction, with the integration of the neuroanatomical, neurochemical, neurogenetic and neuroimmunologic data.

The treatment of OCD is an example of the benefic effects that modern research can have in a relatively short time. Unlike the 80's, when OCD was considered unresponsive to treatment, nowadays, it is known to be a frequent mental disorder, which responds to treatment interventions, despite the fact that it is probably the most difficult anxiety disorder to treat. …