When Cognitive Behavioural Therapy for Obsessive Compulsive Disorder Fails: Service User Perspectives

Background: Cognitive Behavioural Therapy (CBT) is an effective psychological treatment for Obsessive Compulsive Disorder (OCD), but not all service users’ benefit from treatment. The factors involved in non-optimal response have been largely examined from the perspective of therapists. The current study explored the reasons for treatment failure from the perspective of service users. Method: Twelve participants were recruited, six with OCD and six with Panic Disorder (PD), with the latter being included as a comparison group. All participants had undertaken > 2 unsuccessful courses of CBT. The Treatment History Questionnaire (THQ) was used to determine the adequacy of participants’ previous treatment. Qualitative interviews were conducted, and reflexive thematic analysis was used to analyse interview data.Results: The THQ indicated that most participants had undertaken a technically adequate previous course of CBT, meaning that inadequate therapy was unlikely to be the sole reason for treatment failure in the study sample. The qualitative findings indicated three overarching themes capturing participants’ experiences of treatment and its failure: 1) Invalidating and Disempowering Experiences; 2) Factors Relevant to Formulation and Socialisation; and 3) Wider Barriers to Recovery. The first two themes were shared by both OCD and PD participants and the third was specific to OCD. Conclusion: The majority of factors underpinning therapy failure related to the therapeutic interaction and were pertinent to both participants with OCD and PD. In addition, OCD participants described a wider set of socio-contextual obstacles to their benefitting from treatment. Clinical implications are discussed.