Health care provision for patients with obsessive compulsive disorder: Is exposure treatment used?

Introduction: There is much evidence that exposure therapy and response prevention can effectively reduce symptoms of obsessive-compulsive disorder (OCD). Accordingly, almost all cognitive-behavioral therapists in their treatment request to the health insurer suggest exposure therapy as their chosen method for outpatients with OCD. Yet, what about the implementation of exposure therapy in Germany? The present study examines how patients perceive previous treatments they received and what they report about these. The study focused on use and implementation of exposure therapy as recommended by existing treatment guidelines. Methods: In standardized interviews, 57 patients who had formerly undergone psychotherapy treatment were asked their experience during treatment. Answers were analyzed descriptively. Results: Data was provided for a total of 111 psychotherapies (from 56 patients). From the patients' point of view, 83.8% of treatments did not include exposure. Furthermore, more than half of the patients could not recall that they had been prepared for exposure. Detailed analyses revealed that more than 70% of patients said they had not kept self-monitoring protocols, 81% of patients had not prepared a hierarchical list of their OCD symptoms. Conclusions: Our data support the assumption that cognitive-behavioral therapists do not actually treat patients according to their treatment request. In addition, the data indicates the need for further discussion on a more standardized treatment of OCD.