Background With regard to long-term outcome, behaviour therapy is the first choice treatment for obsessive–compulsive disorder (OCD), with or without concomitant selective serotonin reuptake inhibitor (SSRI) medication. Yet, results from research trials, usually restricted to exposure with response-preventions and other symptom-directed techniques, may not be generalisable to people with OCD in community health care services.
Method For more than 20 years we have delivered out-patient behaviour therapy to unselected people with OCD from the community, including those with motivational and compliance problems. Prospective–retrospective follow-ups were carried out from 1–13 years after treatment.
Results This paper describes the applied multimodal, strategic-systemic behaviour therapy, and our partially new model of OCD. Compliant patients achieved the usual success rate of 65–70%, but this drops to 50% if all patients treated are included in the analysis.
Conclusions For major subgroups of OCD, behaviour therapy is a very effective treatment modality. Exposure is essential, but additional (‘causal’) interventions are equally important in about half of the patients from unselected samples. Both behaviour therapy and drug-treatments need to be improved and predictive variables for outcome of either of them are urgently needed.