4,5 Recent reviews assert6,7 that its core ingredients, behavioral and cognitive techniques, share roughly similar efficacy. The overall effect size for psychological

interventions in adult samples is d=1.24 according to a Cochrane review.6 In adolescents, estimates are similar.8 However, several words of caution are necessary in view of studies that find less favorable results.9,10 For example, when dropout rates are considered, response is typically only seen in every second patient.1,11 While Pinard11 concludes in his editorial introduction on Abramowitz’ meta-analysis4 that “OCD therapeutic strategies are [ ...] less than satisfactory for the moment,” treatment reality beyond controlled Inhibitors,research,lifescience,medical trials, the latter usually being conducted with skilled, trained, and highly motivated therapists, may be even worse. The dropout rate seen under standard clinical conditions Inhibitors,research,lifescience,medical is likely to be higher relative

to ideal study conditions. For example, a Spanish study12 reports that of 203 patients (mainly anxiety disorders) seen in a cognitive-behavioral unit 43.8% dropped out mostly at early stages of the intervention. Treatment gap of OCD: the need for improved interventions It often takes up to 10 years until OCD patients seek professional help for their problems, and there is a lag of 6 or more years until the diagnosis is correctly Inhibitors,research,lifescience,medical determined and appropriate treatment is initiated.13,14 The rate of untreated cases for OCD is 59.5% (so-called treatment gap) according to a large WHO study15 However, the few patients receiving psychiatric or psychological help often do not get optimal, evidence-based Inhibitors,research,lifescience,medical treatment. A recent study16 showed that 65% of adult patients with OCD were treated with an SSRI, whereas only 7.5% of the patients received CBT despite its effectiveness.7 A recent German study found that less than 50% of all interviewed psychotherapists (CBT and other) performed exposure and response prevention (ERP) mainly

owing to lack of experience and insufficient training in this technique.17 According Inhibitors,research,lifescience,medical to patients’ reports, the situation is even worse. Approximately GPX6 84% of the sample reported that they did not receive exposure and response prevention at all.18,19 Importantly, treatment success is usually not defined as full symptom remission, but as a symptom decline of 30% to 35% at least on the Yale-Brown ObsessiveCompulsive Scale (this website Y-BOCS),20 which has led to some criticism, for example by Pinard11 who wrote: “as if reducing rituals from 6 to 4 hours were clinically meaningful.” Others21 have noted that outcome criteria are less strict for OCD than for other disorders for which a remission of 50% of symptoms is considered substantial. Thus, many patients remain severely disabled even after a clinically defined successful therapy. Furthermore, modest symptom decline does not necessarily translate into improved quality of life.