General management and advice to patient and family

(ref 174)

• Patients and their relatives can understand the problem better and how to help it by reading and implementing a self-help manual (see below).
• The doctor should explain to them together that giving reassurance or help with rituals may transiently relieve the patient’s anxiety but worsens their problems.
• The doctor can help the patient and family start treatment by agreeing that if the patient seeks reassurance or help with rituals the family will reply 'The doctor says no answer'.
• Exposure to stimuli triggering obsessional thoughts and response prevention (ie prevention of performance of rituals) is effective (ref 175-177) and the improvement lasts longer than that observed with drug treatment (ref 178,179)
• Cognitive therapy involves correcting faulty interpretations and beliefs about  thoughts and their consequences (175-177,180) and is as effective as behaviour therapy (ref 181).

References

174 NICE will publish a guideline on the management of Obsessive-compulsive disorder in February 2005.

175 Greist JH, Marks IM, Baer L et al. Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 2002, 63: 138-145 (CII) This is a randomized controlled trial. Computer-guided behaviour therapy was effective for patients with Obsessive compulsive disorder, although clinician-guided behaviour therapy was even more effective. Systematic relaxation was ineffective.

176 Freeston MH, Ladouceur R. The cognitive-behavioural treatment of obsessions. In: Caballo VE (ed) International Handbook of Cognitive and Behavioural Treatment of Psychological Disorders. Oxford: Pergamon, 1998: 127-160.

177 Salkovskis PM, Kirk J. Obsessional disorders. In: Hawton K, Salkovskis PM, Kirk J, Clark M (eds.) Cognitive Behaviour Therapy for Psychiatric Disorders. Oxford: Oxford University Press, 1988: 129-168.

178 Stern R, Drummond L. The Practice of Behavioural and Cognitive Psychotherapy. Cambridge: Cambridge University Press, 1991

179 Marks IM. Fears, Phobias and Rituals. New York: Oxford University Press, 1987.

180 Soomro GM. Obsessive compulsive disorder. Clinical Evidence 2002, 8: 991-1002. (AI) This is a review. Selective serotonin reuptake inhibitors, behaviour therapy, cognitive therapy and combined treatment (fluvoxamine and behaviour therapy) are beneficial in Obsessive-compulsive disorder.

181 Cottraux J, Note I, Yao SN et al. A randomized controlled trial of cognitive therapy versus intensive behavior therapy in Obsessive-compulsive disorder. Psychother Psychosom 2001, 70(6): 288-297. (BII) This is a randomized controlled trial. Cognitive therapy and behaviour therapy were equally effective for patients with Obsessive-compulsive disorder.

Last edited: 26/1/2004

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