“Phobie à deux” and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive-compulsive disorder

The best way to overcome one’s fears and concerns is to confront them. This is as straightforward as it is true. Many studies show that exposure with response prevention (ERP) is the most efficacious treatment for obsessive-compulsive disorder (OCD), a mental illness characterized by intrusive thoughts (e.g., fears about getting contaminated with germs) and compulsive actions (e.g., washing). Yet, many therapists, including those trained in evidence-based treatment, do not perform ERP for OCD. The present study aimed to elucidate the reasons why. A total of 216 therapists completed an anonymous online survey that inquired whether, to what extent, and how they perform ERP in OCD. We also asked their reasons for not applying ERP in the past.

Most therapists considered ERP an efficacious treatment for OCD. The most frequently cited reasons for not conducting ERP were patients’ lack of motivation, clnicians’ preference for exposure to be performed as a self-help technique, and alleged organizational difficulties (e.g., poor reimbursement for this complex treatment, concerns about insurance coverage). Older therapists and physicians were more reluctant to perform ERP than younger therapists and psychologists. Fear of side effects (e.g., instability when ERP fails) was named by a subgroup of clinicians. In the context of patients’ ambivalence, this may foster “phobie à deux”, that is, exaggerated fears about ERP shared by both patients and their therapists. The article provides a number of recommendations for improving adherence to guidelines.

Read the full paper: Moritz, S., Külz, A., Voderholzer, U., Hillebrand, T., McKay, D., & Jelinek, L. (in press). “Phobie à deux” and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive–compulsive disorder. Cognitive Behaviour Therapy. doi:10.1080/16506073.2018.1494750

Steffen Moritz


Photo from: TheDyslexicBook.com

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