Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore?

• Published in: Comprehensive psychiatry Vol. 120; p. 152357
• Main Authors: Castle, David, Feusner, Jamie, Laposa, Judith M., Richter, Peggy M.A., Hossain, Rahat, Lusicic, Ana, Drummond, Lynne M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023; Elsevier Limited; Elsevier
• Subjects: Acceptance and Commitment Therapy; Adults; Anxiety; Biomarkers; Cognition & reasoning; Cognitive therapy; Digital technologies; Exercise; Flexibility; Humans; Mental depression; Mindfulness; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - therapy; Precision medicine; Psychological interventions; Psychotherapy; Systematic review; Treatment; Biomarkers; Obsessive-compulsive disorder; Treatment; Psychological interventions; Digital technologies
• ISSN: 0010-440X; 1532-8384; 1532-8384
• DOI: 10.1016/j.comppsych.2022.152357

Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response.
Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response.
A number of ‘third wave’ therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more ‘personalised medicine informed’ treatment strategizing for OCD.
There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
•This article cutting edge psychological treatment approaches for adult obsessive compulsive disorder (OCD).•It scopes novel psychological treatments for OCD, along with other non-biological treatment modalities.•Clinical guidance is given as to how these heterogeneous therapies might be deployed.•There is an overview of emerging digital technologies and their place in the therapeutics of OCD.•Finally, we discuss potential biomarkers of treatment response for some of these emerging paradigms.