Jonathan S. Abramowitz

Effects of comorbid Depression on response to treatment for obsessive-compulsive disorder

We examined the effects of comorbid depression on response to treatment for obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy with and without medication. Eighty-seven OCD patients were divided into nondepressed and mildly, moderately, and severely depressed groups on the basis of their pretreatment Beck Depression Inventory (BDI) scores. Each received an intensive cognitive-behavioral treatment program involving exposure with response prevention (EX/RP); 59 (68%) were also taking medication for OCD. Patients with severe initial depression (BDI ≥30) showed significantly less improvement compared to those less depressed or nondepressed; yet, even highly depressed patients showed moderate treatment gains. Failure to habituate to anxiety-evoking stimuli during exposure and a lack of motivation for therapy are considered possible causes of attenuated outcome.

Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD

Studies that have examined the effects of comorbid depression on response to treatment in obsessive-compulsive disorder (OCD) have yielded inconsistent results. We examined treatment outcome for 15 OCD patients with comorbid major depressive disorder (MDD) and 33 OCD patients without MDD. All patients received intensive cognitive-behavioral therapy by exposure and response (ritual) prevention. Improvement in OCD symptoms was observed in both patient groups, and treatment gains were maintained at follow-up. Whereas the presence of a comorbid MDD diagnosis in OCD was not related to treatment failure, nondepressed patients had significantly lower posttreatment and follow-up OCD severity scores.

Cognitive-Behavioral Therapy With and Without Medication in the Treatment of Obsessive-Compulsive Disorder

Cognitive–behavioral therapy (CBT) and pharmacotherapy with serotonin reuptake inhibitors (SRIs) are established monotherapies for obsessive–compulsive disorder (OCD), yet research on their combined efficacy is lacking. Practicing psychologists who treat OCD are thus unable to say definitively whether exposure and ritual prevention would be more successful with concomitant SRI pharmacotherapy. The authors explored this issue in a clinical sample of 56 outpatients who received fee-for-service CBT; 31 (55%) received CBT alone, and 25 (45%) received CBT plus SRI. Both groups made clinically significant and comparable posttreatment gains, suggesting that CBT is effective with or without concomitant pharmacotherapy. Clinical implications are discussed. With the current widespread use of medication to treat a variety of mental health problems, professional psychologists often need to discuss with prospective patients the pros and cons of continuing the medication regimen while undergoing psychotherapy. Conversely, patients who are considering medication may ask their psychologists whether they should do so while receiving psychological services to maximize benefit. Unfortunately, the answers to these questions are often unclear, as research on the relative efficacy of psychotherapy, pharmacotherapy, and their combination is underdeveloped for most psychological disorders. This is certainly the case with obsessive compulsive disorder (OCD), for which the efficacy of cognitive behavior therapy (CBT) and pharmacotherapy with serotonin reuptake inhibitors (SRIs) has been well established (see Abramowitz, 1997; Greist, Jefferson, Kobak,

Health Concerns in Patients With Obsessive-Compulsive Disorder

In the present study, individuals with obsessive-compulsive disorder (OCD) who also had excessive health concerns (n = 56) were compared with OCD individuals without such concerns (n = 343) regarding their OCD symptom severity, types of obsessions and compulsions, insight into the irrationality of their obsessions, and prevalence of generalized anxiety disorder. While the presence of health concerns did not affect the severity of OCD symptoms, the groups differed with respect to the types of symptoms displayed: those with health concerns had more somatic and harm obsessions, and checking compulsions: whereas those without such concerns had more contamination obsessions and washing compulsions. The insight of both groups ranged from poor to excellent, yet the number of individuals with poor insight was greater among those with health concerns than those without. Generalized anxiety disorder was also more prevalent among OCD individuals with excessive health concerns.