Reasons for inadequate utilization of cognitive-behavioral therapy for obsessive-compulsive disorder.

Sir: Cognitive-behavioral therapy (CBT) has repeatedly been found to be effective in the treatment of obsessive-compulsive disorder (OCD), 1 and the Expert Consensus Guidelines for the Treatment of OCD 2 recommend CBT as a first-line treatment of adult OCD along with serotonin reuptake–inhibiting drugs. However, many OCD sufferers never receive adequate CBT treatment; for example, Mancebo et al. 3 recently found that only 38% of OCD sufferers taking part in a longitudinal study of OCD at a major medical center had undergone an adequate trial of CBT in their lifetime. We undertook an Internet-based survey study to better understand this phenomenon in the larger OCD population. Method. We prepared an Internet survey, hosted by the www.surveymonkey.com Web site, consisting of questions for OCD sufferers 18 years or older, asking about demographics, OCD symptoms, and treatment history. This survey was advertised on the Web site of the Obsessive Compulsive Foundation (www.ocfoundation.org), an international not-for-profit organization of OCD sufferers and their families with more than 10,000 members, and was available online between November 11 and December 1, 2006. Results. Two hundred thirty individuals self-identified with OCD responded to the survey and completed at least some of the survey questions. The authors read each survey participant's description of his or her obsessions and/or compulsions to confirm that the survey participant had a likely diagnosis of OCD and eliminated 8 individuals from the sample who were clearly not suffering from OCD. This left 222 respondents upon whom this report is based. While 84% reported having sought drug treatment for their OCD, only 53% reported having sought CBT treatment and only 31% reported having been treated by a specialist in CBT (and those treated by specialists in OCD, regardless of degree, were significantly more likely to report having responded to CBT by a score of 1 or 2 on the Clinical Global Impressions [CGI] scale 4 : OR = 6.9, 95% CI = 1.5 to 32.7). We found no significant differences in gender, ethnicity, family income, or type of medical insurance between OCD sufferers who had sought CBT treatment versus those who had not. However, those diagnosed with OCD by a mental health professional were significantly more likely to seek CBT treatment than those diagnosed by their primary care doctor or a nonprofessional (OR = 2.5, 95% CI = 1.3 to 5.0). In response to 4 possible reasons as to why they did not seek …