title: Out-patient, multi-modal behaviour therapy for obsessive-compulsive disorder.
abstract: BACKGROUND
  With regard to long-term outcome, behaviour therapy is the first choice treatment for obsessive-compulsive disorder (OCD), with or without concomitant selective serotonin reuptake inhibitor (SSRI) medication. Yet, results from research trials, usually restricted to exposure with response-preventions and other symptom-directed techniques, may not be generalisable to people with OCD in community health care services.
  
  
  METHODS
  For more than 20 years we have delivered out-patient behaviour therapy to unselected people with OCD from the community, including those with motivational and compliance problems. Prospective-retrospective follow-ups were carried out from 1-13 years after treatment.
  
  
  RESULTS
  This paper describes the applied multi-modal, strategic-systemic behaviour therapy, and our partially new model of OCD. Compliant patients achieved the usual success rate of 65-70%, but this drops to 50% if all patients treated are included in the analysis.
  
  
  CONCLUSIONS
  For major subgroups of OCD, behavior therapy is a very effective treatment modality. Exposure is essential, but additional ('causal') interventions are equally important in about half of the patients from unselected samples. Both behaviour therapy and drug-treatments need to be improved and predictive variables for outcome of either of them are urgently needed.
authors.affiliation: Universitätskrankenhaus Eppendorf, Psychiatrische und Nervenklinik, Hamburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Hand
mesh_terms: D000223:Adaptation, Psychological; D000553:Ambulatory Care / Q000379:methods*; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004644:Emotions; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D011379:Prognosis