How Effective is Inpatient Treatment for OCD and What Predicts Better Outcomes?

What you need to know

• Inpatient cognitive-behavioral therapy (CBT) treatment for OCD was found to be highly effective in routine clinical care, with large improvements in OCD symptoms.

• Lower general distress, higher social support, and more washing compulsions predicted better treatment outcomes.

• Different factors predicted improvements in obsessions versus compulsions, suggesting tailored approaches may be beneficial.

Effectiveness of inpatient OCD treatment

This study examined the effectiveness of specialized inpatient treatment for obsessive-compulsive disorder (OCD) in routine clinical care settings in Germany. The researchers analyzed data from 1,596 OCD patients who received evidence-based cognitive-behavioral therapy (CBT) during inpatient stays averaging 55-66 days.

The results showed that the inpatient treatment was highly effective:

• There were large improvements in OCD symptoms from pre- to post-treatment, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The average Y-BOCS score decreased from 25.5 to 16.0.

• The effect size for OCD symptom improvement was large (Hedges’ g = 1.34), indicating substantial clinical benefit.

• There were also significant improvements in depression, anxiety, overall psychological distress, and quality of life.

• About 43% of patients achieved treatment response, and 26-28% reached remission of OCD symptoms.

These findings demonstrate that intensive, specialized CBT delivered in an inpatient setting can lead to meaningful improvements for many OCD patients, even those with severe and treatment-resistant symptoms. The large effects are particularly impressive given this was a “real-world” clinical sample rather than a controlled research study.

Predictors of treatment outcome

The researchers also examined what factors predicted better or worse treatment outcomes. Key findings included:

• Lower general psychological distress at the start of treatment predicted greater OCD symptom improvement. This suggests addressing overall distress and coping skills early in treatment may enhance outcomes.

• Higher social support predicted better outcomes. Patients with stronger support networks may be better able to engage in and maintain treatment gains.

• Patients with more washing compulsions showed greater improvement than those with other symptom types. Exposure therapy for contamination fears may be particularly effective in the inpatient setting.

• Higher scores on obsessive thoughts predicted less improvement in obsessions specifically. Pure obsessions without compulsions may be more challenging to treat.

• Higher scores on ordering compulsions predicted less improvement in compulsions. Perfectionism and rigidity associated with ordering symptoms may require additional intervention.

These results highlight potential ways to tailor and enhance OCD treatment. For example, bolstering social support, targeting general distress early on, and adjusting approaches based on symptom subtype could improve outcomes.

Clinical implications

The findings from this study have several important implications for the treatment of OCD:

1. Inpatient CBT programs can be highly effective for OCD and should be considered for severe or treatment-resistant cases.

2. Assessing and enhancing social support may improve treatment engagement and outcomes. Involving family members in treatment when possible could be beneficial.

3. Addressing overall psychological distress and coping skills early in treatment may set the stage for better OCD-specific outcomes.

4. Treatment approaches may need to be tailored based on OCD symptom subtypes. For example:

   • Patients with primarily washing compulsions may do particularly well with standard exposure therapy.
   • Those with high levels of obsessive thoughts may benefit from additional cognitive techniques or metacognitive therapy.
   • Patients with ordering compulsions may require strategies to address perfectionism and rigidity.

5. Combining psychotherapy with medication management may be helpful, especially for patients with severe symptoms or comorbid conditions.

6. Regular assessment of symptoms and functioning throughout treatment can help identify early response or lack of response and guide treatment adjustments.

Conclusions

• Specialized inpatient CBT treatment leads to large improvements in OCD symptoms and associated problems for many patients.

• Lower psychological distress, higher social support, and washing compulsions predict better outcomes.

• Treatment may need to be tailored based on symptom subtype and other individual patient factors.

• Further research on predictors of treatment response can help refine and personalize OCD treatment approaches.

While this study provides valuable insights into OCD treatment outcomes in routine clinical care, more research is still needed on long-term outcomes and how to further enhance treatment for those who do not achieve remission. Nonetheless, the results offer encouragement that effective, evidence-based care for OCD can be successfully implemented in real-world clinical settings.