Cognitive-behavioral therapy (CBT) is a proven and effective treatment for obsessive-compulsive disorder (OCD). Studies have found that many OCD patients see a marked improvement in their symptoms after completing a Cognitive-behavioral therapy program. A new study has found, however, that a specific subset of OCD sufferers may not respond as well to CBT.

Most Obsessive-Compulsive Disorder Responds to Cognitive Behavioral Therapy

The study, conducted by researchers at Aarhus University in Denmark, followed 269 children between the ages of 7 and 17 who had been diagnosed with OCD. All of the participants received a 14-week course of cognitive-behavioral therapy. Those participants who still exhibited OCD symptoms after the 14 weeks were treated either with more CBT or with antidepressant medications (SSRIs). All participants were evaluated after 6 months, 1 year, 2 years, and 3 years.

After three years, the study found that most of the participants had seen significant improvement in their OCD symptoms.

“Part of the overall picture is that almost eighty percent of those we studied were so well-functioning following the cognitive behavioral therapy that after three years they no longer had OCD to a degree that required treatment,” says Per Hove Thomsen, the study’s lead investigator.

An Unusual Exception

One of the study’s results stood out, however. Among the 59 participants who seemed in danger of an OCD relapse after three years, a significant number exhibited a specific kind of symptom. They suffered from the “contamination and washing variant” of OCD, and they were limited in their insight into their condition. That is, they are compelled to act out behaviors revolving around cleanliness, and they are not especially aware of how the behaviors affected them.

These participants responded well to CBT during the 14-week treatment period, but when they were evaluated after three years, they were not doing as well.

“The tricky thing is that they initially react positively to the cognitive behavioral therapy, and they, therefore, leave the mental health services again after the 14-week period of treatment,” says Sanne Jensen, another of the study’s authors. “But when we contact them again after three years, we can see they demonstrate a worrying development – they have gotten worse.”

The authors don’t draw any conclusions about why this particular type of OCD might be resistant to cognitive behavioral therapy. They do, though, see the need for mental healthcare providers to be aware of the limitations of CBT in these cases, especially since the therapy may seem at first to be delivering good results.

“The conclusion isn’t that you’re doomed to a life-long disabling OCD if you’re a teenager with cleanliness rituals and poor insights into your condition,” says Thomsen. “There are also young people from this patient group who don’t suffer a relapse. On the contrary, the conclusion is that we need to become better at following up on precisely these patients because otherwise, we risk leaving them in the lurch.”

Aarhus University, Standard treatment programs for OCD are not always enough
The Journal of Child Psychology and Psychiatry, Distinct trajectories of long‐term symptom severity in pediatric obsessive-compulsive disorder during and after stepped‐care treatment

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