Out-patient, multi-modal behaviour therapy for obsessive-compulsive disorder

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 multi-modal, 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.