Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-12T22:42:52.487Z Has data issue: false hasContentIssue false
  • English
  • Français

Out–patient, multimodal behaviour therapy for obsessive–compulsive disorder

Published online by Cambridge University Press:  06 August 2018

Iver Hand
Iver Hand*
Affiliation:
Universitä tskrankenhaus Eppendorf, Psychiatrische und Nervenklinik, Martinistr. 52, 20246 Hamburg, Germany. Fax: +49 40 47175025
Get access Rights & Permissions [Opens in a new window]

Abstract

Background With regard to long-term outcome, behaviour therapy is the first choice treatment for obsessive–compulsive disorder (OCD), with or without concomitant selective serotonin reuptake inhibitor (SSRI) medication. Yet, results from research trials, usually restricted to exposure with response-preventions and other symptom-directed techniques, may not be generalisable to people with OCD in community health care services.

Method For more than 20 years we have delivered out-patient behaviour therapy to unselected people with OCD from the community, including those with motivational and compliance problems. Prospective–retrospective follow-ups were carried out from 1–13 years after treatment.

Results This paper describes the applied multimodal, strategic-systemic behaviour therapy, and our partially new model of OCD. Compliant patients achieved the usual success rate of 65–70%, but this drops to 50% if all patients treated are included in the analysis.

Conclusions For major subgroups of OCD, behaviour therapy is a very effective treatment modality. Exposure is essential, but additional (‘causal’) interventions are equally important in about half of the patients from unselected samples. Both behaviour therapy and drug-treatments need to be improved and predictive variables for outcome of either of them are urgently needed.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S35: New perspectives in research and treatment of obsessive-compulsive disorder , August 1998 , pp. 45 - 52
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baer, L. (1991) Getting Control. Boston, MA: Little, Brown & Co.Google Scholar
Baxter, L., Saxena, S., Brody, A., et al (1991) Brain mediation of obsessive–compulsive disorder symptoms: evidence from functional brain imaging studies in the human and nonhuman primate. Seminars in Clinical Neuropsychiatry. 1, 32–47.Google Scholar
Calvocoressi, L., Lewis, B., Harris, M., et al (1991) Family accommodation in obsessive-compulsive disorder. American Journal of Psychiatry, 152, 441–443.Google Scholar
Erikson, E. (1978) Toys and Reasons: Stages in the Ritualization of Experience. London: Marion Boyars.Google Scholar
Foa, E. & Wilson, R. (1991) Stop Obsessing. Self-Help for Obsessions and Compulsions. New York: Bantam Books.Google Scholar
Friesen, J. (1985) Structural-Strategic Marriage and Family Therapy. New York: Gardner Press.Google Scholar
Gazzaniga, M. S. (1992) Nature's Mind: The Biological Roots of Thinking. Emotions, Sexuality, Language and Intelligence. New York: Basic Books.Google Scholar
Greist, J. H. & Jefferson, J. W. (1998) Pharmacotherapy for obsessive-compulsive disorder. British Journal of Psychiatry, 173 (suppl. 35), 64–70.Google Scholar
Hand, I. (1986) Verhaltenstherapie und Kognitive Therapie in der Psychiatrie. In Psychiatrie der Gegenwart I (eds Kister, K. P., Lauter, H., Meyer, J. E., et al), pp. 277–306. Berlin: Springer Verlag.Google Scholar
Hand, I. (1988) Obsessive-compulsive patients and their families. In Handbook of Behavioral Family Therapy (ed. Falloon, I. R. H.), pp. 231–256. New York: Guilford Press.Google Scholar
Hand, I. (1991) Aggression und soziale Defizite bei psychischen Erkrankungen. In Aggression und Autoaggression (ed. Pöldinger, W.), pp. 27–46. Duphar Med. Script, Bd. 8, Hannover: Duphar.Google Scholar
Hand, I. (1993a) Verhaltenstherapie für Zwangskranke und deren Angehörige. In Therapie Psychiatrischer Erkrankungen (ed. Möller, H. J.), pp. 508–528. Stuttgart: Ferdinand Enke Verlag.Google Scholar
Hand, I. (1993b) Exposition-Reaktions-Management (ERM) in der strategisch-systemischen Verhaltenstherapie. Verhaltenstherapie, 3, 61–65.Google Scholar
Hand, I. (1997) “Zwangs-Spektrum-Störungen” oder “Nicht-Stoffgebundene Abhä ngigkeiten”? In Psychotherapie in der Psychiatrie (eds Mündt, Ch., Linden, M. & Barnett, W.), pp. 209–219. Berlin: Springer Verlag.Google Scholar
Hand, I. (1998) Pathological gambling: a negative state model and its implications for behavioural treatments. CNS Spectrums, 3, 58–71.Google Scholar
Hand, I., Spoehring, B. & Stanik, E. (1977) Treatment of obsessions, compulsions and phobias as hidden couple-counselling. In The Treatment of Phobic and Obsessive Compulsive Disorders (eds Boulougouris, J. C. & Rabavilas, A. D.), pp. 105–114. Oxford: Pergamon Press.Google Scholar
Hand, I. & Tichatzki, M. (1979) Behavioral group therapy for obsessions and compulsions: first results of a pilot study. In Trends in Behavior Therapy (eds Sjöden, P. O., Bates, S. & Dockens, W S. III), pp. 269–298. New York: Academic Press.Google Scholar
Hohagen, F., Winkel man, G., Rasche-Räuchle, H., et al (1998) Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy. British Journal of Psychiatry, 173 (suppl. 35), 71–78.Google Scholar
James, I. A. & Blackburn, I.-M. (1995) Cognitive therapy with obsessive-compulsive disorder. British Journal of Psychiatry, 166, 444–450.Google Scholar
Lacher, M. (1989) Langzeitaffekte von Kurzzeit-Verhaltenstherapie bei zwangsneurotikern. PhD thesis. University of Hamburg.Google Scholar
Lazarus, A. (1976) Multi-Modal Behavior Therapy. New York: Springer.Google Scholar
Marks, I. M. (1978) Living with Fear. New York: McGraw-Hill.Google Scholar
Marks, I. (1987) Fears, Phobias and Rituals. Oxford: Oxford University Press.Google Scholar
McColloch, M. & Gilbert, B. (1991) Development and maintenance of aggressive behavioral patterns. In Personality, Social Skills, and Psychopathology (eds Gilbert, D. & Conolly, J.), pp. 185–210. New York: Plenum Press.Google Scholar
Münchau, N., Hand, I., Schaible, R., et al (1996) Aufbau von Selbsthilfegruppen für Zwangskranke unter verhaltenstherapeutischer Expertenanleitung: empirische Ergebnisse. Verhaltenstherapie, 6, 143–161.Google Scholar
Pato, M. T., Zohar-Kadouch, J. & Murphy, D. L. (1988) Return of symptoms after discontinuation of clomipramine with obsessive-compulsive disorder. American Journal of Psychiatry, 145, 1521–1525.Google Scholar
Salkovskis, P. & Kirk, J. (1989) Obsessional disorder. In Cognitive Behaviour Therapy for Psychiatric Problems (eds Hawton, K., Salkovskis, P. M., Kirk, J. & Clark, D. M.), pp. 129–168. Oxford: Oxford University Press.Google Scholar
Schwartz, J. M. & Beyette, B. (1996) Brain Lock: free Yourself from Obsessive-Compulsive Behavior. New York: Regan Books.Google Scholar
Van Balkom, A. J., van Oppen, P., Vermeulen, A. W., et al (1994) A meta-analysis on the treatment of obsessive compulsive disorder: a comparison of antidepressants, behavior, and cognitive therapy. Clinical Psychology Review, 14, 359–381.Google Scholar
Van Oppen, P., De Haan, E., Van Balkon, A., et al (1995) Cognitive therapy and exposure in-vivo in the treatment of obsessive-compulsive disorder. Behavior Research and Therapy, 33, 379–390.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.