Purpose: To study the treatment response in patients with moderate-to-severe obsessions and compulsions based on a stepwise treatment algorithm by our clinical guidelines. In step 1, all receive cognitive behavioral therapy (CBT) with Exposure to Response Prevention (E/RP) in 14 sessions and several sessions of family interventions. An important goal is to study what predicts a good and inadequate treatment response. In the second step, the aim is to investigate whether those who have not responded to treatment in step 1 are best treated with medication or whether an extension of the "dose" of CBT is best. A parallel goal is to study which factors can predict treatment outcomes. In the third step, it is tested whether augmentation of SSRI with Aripiprazole can help treatment-refractory patients (i.e., those who neither respond to CBT nor SSRI). In addition to psychosocial factors, we also study genetic aspects, including the genetics of treatment response and, in a subgroup, neurochemical factors.
Results: A deeper understanding of the outcome of CBT treatment, including its sustainability and which factors are associated with poor outcomes. Whether continued CBT can lead to further improvement, and whether Sertraline (an SSRI) is superior to continued CBT with a symptom relief that corresponds to that seen in previously untreated patients. We also believe predicting which patients need SSRI and which should have extended CBT will be possible.
Practical Significance and Research Implications: Within the clinics, the study should provide practical guidance on acting when patients with OCD do not respond to initial evidence-based treatment. The analysis will also provide an understanding of which patients are at the most significant risk of relapse in OCD and chronic OCD.
Project duration: 2008-2013 (treatment in steps 1-3), 2009-2015: Long-term follow-ups.
Funding: Assessment, treatment, and symptom ratings have been financed by the participating units, either through the hospital principal donating the time or through external grants for non-healthcare-motivated symptom ratings and assessments. Within RBUP, grants from "Health & Rehabilitation" have financed a doctoral student, NFR has financed a doctoral student, and 1/2 research coordinator and provided funds for particular purposes (method fidelity assessment of CBT, reliability test of CY-BOCS ratings, and in a subpopulation, magnetic resonance spectroscopic examination. In Århus, Denmark, funds have been raised for a doctoral student studying neuropsychology in a subgroup.