Abstract
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive–compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive–behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD–symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.
Highlights
Obsessive–compulsive disorder (OCD) is a serious and debilitating disease [1, 2]
This study sheds some light on the routine clinical care of OCD patients: first, by determining the effectiveness of an inpatient OCD treatment on symptom-specific as well as functional outcomes under everyday health care conditions; and secondly, by identifying important predictors of treatment outcome in a large sample of OCD patients being treated in German clinics offering specialized inpatient psychotherapy
The overall large unstandardized, but corrected effect sizes indicate that OCD treatment is delivered effectively in routine clinical inpatient care, despite the fact that the pre-/posteffect sizes were marginally lower than those reported in other studies [48] and a COCHRANE review [49]
Summary
Patients suffering from OCD are usually treated with cognitive–behavioral therapies (CBT). These findings lead to the conclusion that ERP and CT can be considered the “gold standard” in the treatment of OCD. CBT is considered a first line, evidence-based psychological treatment in OCD, its integration into daily clinical practice is hampered by several problems, e.g., patients’ lack of motivation, limited numbers. This research-practice gap is supported by studies showing that less than half of therapists regularly use ERP [7] and about 21% of psychotherapists trained in CBT never or rarely use ERP in the outpatient treatment of OCD [8]. From the patients’ perspective, two fifths of OCD patients in one study reported that they had never received CBT with ERP [9]. The consequent use of ERP in an inpatient setting appears to be a promising approach, since a higher treatment dose can be delivered by several therapists
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