Obsessive-Compulsive Disorder: Therapy

General measures

  • A detailed history (taking of medical history) and physical examination should be performed. Furthermore, a psychiatric presentation should be made to review/initiate the severity of illness, appropriate medication (drugs) or psychotherapeutic strategies, if necessary.
  • Avoidance of psychosocial stress:
    • Anxiety

Possible therapeutic procedures

  • Deep brain stimulation (THS; synonym: deep brain stimulation; English : deep brain stimulation, DBS) in the area of the capsula interna, the nucleus accumbens, and the nucleus subthalamicus may be of success.In the future, brain pacemakers will be available for conspiracy, which can be individually adjusted to the brain activity of the patients.
  • Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy); should not be performed because of lack of efficacy for the treatment of patients with refractory obsessive-compulsive disorder [recommendation grade A].
  • Transcranial direct current stimulation (Engl. Transcranial direct current stimulation, tDCS) – noninvasive, painless, and completely reversible procedure for electrostimulation of the brain; direct current is applied via electrodes attached to the scalp, altering cortical excitability and neuronal activity; the inhibitory influence of cathodal stimulation is thought to promote symptom reduction; there is insufficient evidence to provide a clear conclusion for routine use.
  • Transcranial magnetic stimulation (TMS); “noninvasive” brain stimulation technique; should not be performed because of lack of efficacy for treating patients with refractory obsessive-compulsive disorder [recommendation grade A].

Psychotherapy

  • Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness [for severe obsessive-compulsive disorder].
    • Self-management as part of coping with the illness; in this context also references to self-help contact points.
    • Individual interventions
      • Psychoeducational intervention to increase knowledge of the disease.
      • Training of everyday and social skills
      • Artistic therapies
      • Occupational therapy – work or occupational therapy.
      • Movement and sports therapies
      • Health promotion interventions
    • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.
  • In obsessive-compulsive disorder, cognitive behavioral therapy (CBT) is indicated in many cases. [Grade of recommendation: A]This may involve steadily increasing exposure to triggering causes.
  • Bergen 4-day therapy (B4DT; four consecutive days, groups of six patients, equal number of therapists):
    • Day 1: information about obsessive-compulsive disorder and the course of the planned exposure.
    • Day 2 + 3: eight to ten hours of intensive exposure with response prevention in a series of situations close to everyday life.
    • Day 4: learning experiences from the two exposure days are summarized; discussion of how to consistently implement the learned strategies in everyday life.

    RESULT: After treatment, 91.1 percent showed a clinically relevant response (improvement) and 72.2 percent were in remission. Three months after B4DT, the response rate was still 84.4 percent and the remission rate was 67.7 percent.

  • Predictors of efficacy of cognitive behavioral therapy for obsessive-compulsive disorder (modified from):
    • Positive predictors (predictor variable):
      • Compulsive acts are in the foreground
      • Low depressive symptomatology
      • Absence of superfluous ideas
      • Good psychosocial integration, for example, firm partnership
      • High compliance
    • Negative predictors:
      • Very early manifestation of the disorder in childhood (“early onset”).
      • Obsessive thoughts are in the foreground / pronounced obsessive-compulsive symptomatology.
      • Severe depressive symptomatology
      • Severe anxiety symptomatology
      • Schizotypal disorder
      • Borderline disorder
      • Collective compulsions
      • Sexual/religious compulsions
      • Tic disorder
      • Pronounced magical thinking
      • Unemployment
  • Detailed information on psychosomatics (including stress management) can be obtained from us.