Patients with OCD Prefer Psychotherapy

Less popular options included antidepressants and experimental therapies such as brain surgery

Peter Simons
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A new study reveals that patients with obsessive-compulsive disorder (OCD) prefer therapy to psychiatric medications, brain surgery, and alternative treatments. Obsessive-compulsive disorder (OCD) impacts approximately 2% of the population and is typically considered a long-term chronic illness. Exposure and Response Prevention (ERP) may be the most well-supported treatment for (OCD). However, dropout rates indicate that some patients may prefer an alternative therapy. Patient preference may play a role in whether an individual improves when given any particular treatment.

Research suggests that psychotherapy may be the preferred treatment for OCD. Photo credit: Flickr
Research suggests that psychotherapy may be the preferred treatment for OCD. Photo credit: Flickr

Other treatments for OCD include medication, acceptance and commitment therapy, yoga, and brain surgery. A wide variety of medications are used to treat OCD, including benzodiazepines, antidepressants, and antipsychotics, often in conjunction with ERP. Acceptance and commitment therapy (ACT) is an alternative psychotherapy treatment that incorporates some aspects of ERP along with mindfulness and acceptance-based strategies. Two forms of surgical intervention, deep brain stimulation (DBS) and gamma knife surgery, are supported by early research. Kundalini yoga has received very limited empirical support.

Given these various approaches, patient preference may be an important factor in treatment choice. A new study, published online ahead of print in Psychiatric Services in Advance, examined patient preferences for the myriad treatments available. ERP was found to be the most desired treatment, followed by serotonin reuptake inhibitor (SSRI) antidepressants, which correlates with the level of empirical support for these two approaches. In terms of alternative therapies, ACT was highly regarded by patients, while surgical procedures such as DBS and gamma knife surgery were rated the lowest, below Kundalini yoga. Perhaps unsurprisingly, patients would rather do yoga than have brain surgery.

Patients who were wealthier, had a longer history of OCD treatment, and had private insurance were more likely to prefer SSRIs as a first-line treatment for OCD. The researchers theorized that this may be due to this group having “received high-quality psychiatric care that afforded them the time and attention to discuss and resolve concerns about medication.” That is, people without these resources may have had poor experiences with medication management in which they felt pressured or their concerns were not heard. Psychotherapy may have provided an approach tailored to their individual concerns, making it more desirable.

Another finding was that those who were already taking medications (whether SSRIs or benzodiazepines) preferred to add ERP rather than antipsychotics if needed to augment their treatment. The researchers write that “this may reflect the desire to avoid additional psychiatric medication.” Patients seem to be aware of the side effect burden of psychiatric medication and the effectiveness of psychotherapy for OCD, and this is reflected in their preferences.

Although this was a small online survey-based study, it provides evidence that patients have particular opinions regarding OCD treatment that may be based on their financial and insurance resources. These predilections may impact treatment adherence and dropout rates. This illuminates the need to tailor treatment approaches based on individual preferences and past experiences in order to maximize the effectiveness of treatment.

 

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Patel, S. R., Galfavy, H., Kimeldorf, M. B., Dixon, L. B., & Simpson, H. B. (2016). Patient preferences and acceptability of evidence-based and novel  treatments for obsessive-compulsive disorder. Psychiatric Services in Advance. doi: http://dx.doi.org/10.1176/appi.ps.201600092 (Abstract)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

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6 COMMENTS

  1. I am always concerned about how patients know what they prefer, given a bunch of options that they never have tried before.

    As a patient, I prefer the treatment that shows the greatest chances of success with the fewest risks and costs.

    However, if patient preference is determinant in successful treatment or not, research on efficacy and effectiveness of treatment is kind of redundant. Just do what the patient likes.

    But why a patient likes something can be heavily influenced by media, advertising, provide expertise, previous good/bad experiences, what a person thinks others should want them to like, etc., so this can be manipulated to serve the needs of others.

    Basically, whenever patient preference becomes a factor in overall success of a treatment, I think it highlights that placebo effects are are most at play, and perhaps a rethinking of diagnosis/treatment altogether is in order. At the very least, it should prompt a meaningful discussion early on about how there are several options that may be helpful, and what is most helpful is that you like and can tolerate and can pay for an option enough to stick with it, and go from there.

  2. OCD
    is hormones imbalance in human brains.Not serotonin imbalance.
    Interesting is here one thing.No-one from commentators on MIA
    blogs and same is with MIA staff,isn’t comfortble with such biology
    behind my knowledge.I can predict future with my knowledge.I can
    tell,that era of human DBS cyborgs is coming.Era,of massive forced
    laser lobotomies.Era,of bio-chemical detection of madness,trough
    blood and urine tests,for dopamine and serotonin natural levels
    in human brains.Hardly can anyone prevent such future,without
    even try,to challenge it.But I will,on my own.

  3. This research supports the use of the top evidence-based treatments for OCD: ERP therapy and SSRIs. Unfortunately medication only made my son, who was suffering with severe OCD, worse and I wrote about his journey on Mad in America: https://www.madinamerica.com/2013/02/dans-journey-through-ocd-2/.
    With years of hard work doing ERP therapy my son recovered. Today he is a young man living life to the fullest. I recount my family’s story in my critically acclaimed book, Overcoming OCD: A Journey to Recovery (Rowman & Littlefield, January 2015) and discuss all aspects of the disorder on my blog at http://www.ocdtalk.wordpress.com. There truly is hope for all those who suffer from this insidious disorder!

  4. If someone is displaying behaviors which are characterized as ~~~OCD~~~, then most likely they are under stress, under pressure, and living with a compromised social legitimacy.

    So telling them that they have some sort of a disorder and need psychotherapy in order to be made passably acceptable to most people most of the time, is predatory abuse. I say predatory because it preys on those who have already been humiliated and denigrated until they are made vulnerable.

    So it is important that we stand with those, adults and children, who are being fed this, and stand with them as they tell off the disorder doctors and the psychologists.

    And then if this is being done to children, parents driving them to FixMyKid doctors, then either those doctors are reporting each case to Child Protective Services, or they need to be charged with felonies.

    Nomadic

  5. I read the comment from the person diagnosed with OCD and then referred to a psychiatrist for “drug therapy.” Yes, this is the first line approach for everything if you go to a “mental health clinic.” As far as OCD is concerned, there are even less “drugs”, if any, really regarded as a “first line treatment.” I say this, because, I had mistakenly “diagnosed” with OCD. It actually came first from “no other” than a “paper report, multiple choice test” the psychiatrist gave me that I look back had less scientific basis than many of the online personality tests available now; even those that want to tell you your personality from your favorite article of clothing or some such nonsense. All the mental health system is is a legal, societal and cultural approved place for drug pushers and those who tragically get duped they need those drugs. There really is no regard for the person at all. They are just seem as someone they can push their drugs into. I think this is more than just normal greed, in that, most of the drugs I received were the inexpensive generics and they still pushed. Of course, I was prescribed those newer, badder drugs that had no generic equivalent. But, it must be remembered, it is beyond normal greed, although greed is present. This is especially if you remember the majority of drugs prescribed are generic; but, considering that most people will take at least, maybe four or more drugs, at least one is a very big money non generic. By the way, if you even “objectively” looked at the personality profile for the OCD diagnosis and knew me, even at least superficially, you would know it was a joke. Yet, this “diagnosis” persisted for me almost until I totally stopped my contact with the psychiatrist. Thank you.