OCD research update

This past week saw the annual meeting of the Association of Behavioral and Cognitive Therapies, or ABCT. This is the largest American organization of cognitive-behavioral researchers and therapists. Every year, the latest research is presented on cognitive-behavioral therapies for various types of problems, ranging from anxiety to depression to psychosis. This year one of the important projects discussed was the Brown Longitudinal OCD Study. This research study focused on the long-term changes seen in people with OCD who sought help for their symptoms. The study is one of the largest of its kind.

One of the interesting findings to come from this study are estimates of how many people with OCD have tried various forms of treatment. Of the people studied, 86% had been prescribed SSRI's like Paxil, Prozac, or Zoloft. 54% of the people had received cognitive-behavioral therapy (CBT). That means that the medications were tried more than 50% more frequently than CBT. This may have occurred for several reasons. People may be more interested in a treatment that doesn't require weekly visits, or at-home exercises. Perhaps people tended to visit a physician about their symptoms instead of a therapist. Perhaps CBT was not readily available in the places the study participants lived. Perhaps they were not aware of CBT, but were aware of medications that can help OCD symptoms. Whatever the reasons, the Brown Longitudinal OCD study showed that among people who were taking an SSRI at the time they started the study, 62% described themselves as experiencing significant improvement. Of those people who had received CBT in the past year, 67% rated themselves as experiencing significant improvement. These two numbers (62% vs. 67%) are close enough that we can describe SSRIs and CBT as comparably helpful in this study. Other studies have shown similar results.

Since CBT and medications for OCD work about equally well in many research studies, why are medications used more widely? Perhaps part of the answer lies in people's personal preference. But perhaps part lies in the media's messages about the topic. Here I am referring to advertising. While the pharmaceutical industry only allocates 14% of its advertising moneys on television, radio, and other advertising directly to consumers, this amounts to approximately $8 billion per year (using 2004 figures as described in a January 2008 study published in the Public Library of Science - Medicine). When one considers the essentially negligible amount of funds dedicated to the advertising of CBT, the we can begin to make sense of the disparity between how often each treatment is given.

A future post will be devoted to other ways in which the pharmaceutical industry affects the practice of healthcare in the U.S., and some of the reasons why this happens (see also http://www.sciencedaily.com/releases/2008/01/080105140107.htm).