Obsessive-compulsive disorder (OCD) is a potentially debilitating mental health condition that centers on unpleasant, repetitive mental fixations, as well as ritualistic behaviors designed to reduce the potency of those fixations. Doctors commonly try to control the symptoms of OCD with antidepressant medications called SSRIs; however, these medications fail to produce an adequate benefit in substantial numbers of patients. In a study published in September 2013 in the journal JAMA Psychiatry, a multi-institution research team assessed the effectiveness of secondary treatments used for these antidepressant-resistant individuals. The members of the team confirmed the superior benefits of one particular type of psychotherapy, called exposure and ritual prevention therapy, in OCD treatment.
OCD Medication Basics
Doctors commonly use two types of medications to control the symptoms of obsessive-compulsive disorder: antidepressants and anti-anxiety drugs (also known as anxiolytics). While both of these medication types provide clear treatment benefits in at least some individuals, antidepressants likely produce better results than anxiolytics, the National Institute of Mental Health reports. The specific antidepressants known to improve the symptoms of OCD typically belong to a group of medications called SSRIs (selective serotonin reuptake inhibitors), which achieve their effects by altering key portions of the brain’s everyday chemical environment. Common examples of SSRIs used in OCD patients include fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and escitalopram (Lexapro). Another frontline medication used in OCD treatment, called venlafaxine (Effexor), belongs to a related group of antidepressants called SNRIs (serotonin-norepinephrine reuptake inhibitors).
Antidepressants may take up to 12 weeks to ease the effects of obsessive-compulsive disorder, and even after this extended timeframe, significant numbers of people don’t see meaningful improvement in their OCD symptoms. Doctors may attempt to use medications called antipsychotics to address the symptoms of these antidepressant-resistant individuals. Specific antipsychotics used for this purpose include aripiprazole (Abilify), olanzapine (Zyprexa), haloperidol (Haldol) and risperidone (Risperdal). Current studies indicate that the best results obtained from these medications come from the use of risperidone.
Exposure and Ritual Prevention Therapy Basics
Mental health professionals also frequently address obsessive-compulsive disorder with forms of psychotherapy that fall into a treatment category known as cognitive behavioral therapy or cognitive behavior therapy (CBT). Generally speaking, all forms of this therapy identify dysfunctional reactions that affected individuals experience during moments of high stress, then teach those individuals new ways to respond to stress’s impact. The most effective form of CBT for people with OCD is exposure and ritual prevention therapy, also known as exposure and response prevention therapy. During the initial stage of this approach, a therapist intentionally exposes his or her OCD-affected patients to circumstances that trigger the obsessive fixations that dominate their mental lives. During the second stage of the therapy, a therapist teaches his or her patients how to stop participating in the ritualistic behaviors that they normally use to cope with the mental/emotional strain of their obsessions.
In the study published in JAMA Psychiatry, researchers from Columbia University and the University of Pennsylvania examined the effectiveness of exposure and ritual prevention therapy in a group of 100 people with OCD who did not gain adequate symptom relief from antidepressant medications. They also examined the effectiveness of the antipsychotic medication risperidone in antidepressant-resistant OCD patients, and compared the effectiveness of both exposure and ritual prevention therapy and risperidone to placebo medications with no inherent treatment benefit.
After reviewing their findings, the researchers concluded that roughly 80 percent of the antidepressant-resistant patients responded to exposure and ritual prevention therapy to some extent. Approximately 43 percent of the patients who received the therapy experienced a steep drop in their OCD-related symptoms that allowed them to function more or less normally. By comparison, roughly 23 percent of the patients responded at least partially to the effects of risperidone, while approximately 13 percent of the patients experienced symptom remission while using the antipsychotic drug. Fifteen percent of the patients responded at least partially to the psychological effects of placebo treatment, while 5 percent of the patients experienced a remission of their OCD symptoms while using a placebo.
As a result of their findings, the study’s authors recommend that doctors offer their antidepressant-resistant OCD patients treatment with exposure and ritual prevention therapy before resorting to treatment with risperidone or any other antipsychotic medication. This is an especially important recommendation, since psychotherapy doesn’t produce the types of side effects that can commonly occur in people taking antipsychotics.