Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Obsessive compulsive disorder: integration of cognitive-behaviour therapy and clinical psychology care into the primary care context

Michael Kyrios A C , Richard Moulding A and Barbara Jones A B
+ Author Affiliations
- Author Affiliations

A Swinburne Psychological, Clinical, Health and Evaluation (SwinPsyCHE) Research Centre, Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Vic. 3122, Australia.

B Australian Catholic University, Fitzroy, Vic. 3065, Australia.

C Corresponding author. Email: mkyrios@swin.edu.au

Australian Journal of Primary Health 16(2) 167-173 https://doi.org/10.1071/PY08074
Published: 19 May 2010

Abstract

In primary care, evidence-based psychological treatments for obsessive compulsive disorder (OCD), such as cognitive behaviour therapy (CBT), have not been readily available. We aimed to develop models of care for OCD that account for barriers to access and can be integrated into general practice settings. Multiple methodologies and sources were utilised, including literature reviews, a reference group, focus groups, interviews and questionnaire responses from consumers, psychologists and/or GPs. It was found that there were similarities and some differences among stakeholders in attitudes and knowledge about OCD, and views about treatment and assessment in primary care. Three models of care for patients with OCD were developed and integrated into a treatment program operating through a division of general practice. Participating GPs preferred referral to a specialist clinic, irrespective of participation in an educational program about OCD. Based on these findings, it is suggested that effective integration of specialist CBT treatments for OCD into primary care is possible if the needs and views of all stakeholders are accounted for.

Additional keywords: anxiety, general practice, mental health.


Acknowledgements

This research project was funded by Beyondblue, Victorian Centre of Excellence in Depression and Related Disorders. Thanks to the Anxiety Recovery Centre of Victoria (ARCVic) and to the participating Division of General Practice for their involvement in the project.


References


Andrews G, Henderson G, Hall W (2001) Prevalence, comorbidity, disability and service utilisation: overview of the Australian Mental Health Survey. The British Journal of Psychiatry 178, 145–153.
Crossref | GoogleScholarGoogle Scholar | PubMed | CAS | open url image1

Australian Bureau of Statistics (2007) National survey of mental health and wellbeing: summary of results. ABS Cat No. 4326.0. Australian Bureau of Statistics, Canberra.

Botega N, Mann A, Blizard R, Wilkinson G (1992) General practioners and depression – first use of the depression attitude questionnaire. International Journal of Methods in Psychiatric Research 4, 169–180. open url image1

Eisen JL, Goodman WK, Keller MB, Warshaw MG, De Marco LM , et al. (1999) Patterns of remission and relapse in Obsessive-Compulsive Disorder: a 2-year prospective study. The Journal of Clinical Psychiatry 60, 346–351.
PubMed |  CAS | open url image1

Franklin ME , Foa E (1998) Cognitive-behavioural treatments for obsessive-compulsive disorder. In ‘A guide to treatments that work’. (Eds PE Nathan, JM Gordon) pp. 339–357. (Oxford University Press: Oxford)

Frost RO , Steketee G (Eds) (2002) ‘Cognitive approaches to obsessions and compulsions: theory, assessment, and treatment.’ (Pergamon: Amsterdam)

Hofmann SG, Smits JAJ (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry 69, 621–632.
PubMed | open url image1

Jones B , Kyrios M (2005) Knowledge of and attitudes to obsessive-compulsive disorder: Implications for treatment. In ‘35th Annual Congress of the European Association for Cognitive and Behavioural Psychotherapies, Thessaloniki, Greece, 21–24 September’.

Kyrios M (2003) Exposure and response prevention in the treatment of obsessive-compulsive disorder. In ‘Obsessive-compulsive disorder: theory, research and treatment’. (Eds R Menzies, P De Silva) pp. 259–274. (John Wiley & Sons: Chichester)

Kyrios M , Jones B (2007) Disseminating cognitive-behaviour therapy for OCD through primary care. Paper presented at the World Psychiatric Conference, Melbourne, Australia, 28 November–2 December.

Kyrios M , Hordern C , Nedeljkovic M , Bhar S , Moulding R , Doron G (2007) Prediction of outcome following individual manualised cognitive-behaviour therapy for Obsessive-Compulsive Disorder. Paper presented at the World Psychiatric Conference, Melbourne, Australia, 28 November–2 December.

March JS, Frances A, Kahn DA, Carpenter D (1993) The expert consensus guideline series: treatment of Obsessive Compulsive Disorder. Journal of Clinical Psychiatry 58(Suppl. 4), 3–72. open url image1

McCall L, Clarke DM, Rowley G (2002) A questionnaire to measure general practitioners attitudes to their role in the management of patients with depression and anxiety. Australian Family Physician 30(3), 291–297. open url image1

Murray C , Lopez AD (1996) ‘Global burden of disease: a comprehensive assessment and morbidity from disease, injuries, and risk factors in 1990 and projected to 2020.’ (Harvard School of Public Health: Cambridge, MA)

NICE (2005) Quick reference guide – obsessive compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. NICE Clinical Guideline 31. National Institute for Health and Clinical Excellence, London.

Obsessive Compulsive Cognitions Working Group (1997) Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy 35, 667–681.
Crossref | GoogleScholarGoogle Scholar | PubMed | open url image1

Pirkis JE, Blashki GA, Murphy AW, Hickie IB, Ciechomski L (2006) The contribution of general practice based research to the development of national policy: case studies from Ireland and Australia. Australia and New Zealand Health Policy 3, 4–XXX.
Crossref | GoogleScholarGoogle Scholar | PubMed | CAS | open url image1

Rasmussen SA, Eisen JL (1992) The epidemiology and clinical features of Obsessive-Compulsive Disorder. The Psychiatric Clinics of North America 15, 743–748.
PubMed |  CAS | open url image1

Rosa-Alcázar AI, Sánchez-Meca J, Gómez-Conesa A, Marín-Martínez F (2008) Psychological treatment of obsessive-compulsive disorder: a meta-analysis. Clinical Psychology Review 28, 1310–1325.
Crossref | GoogleScholarGoogle Scholar | PubMed | open url image1

Salkovskis P (1985) Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy 23, 571–583.
Crossref | GoogleScholarGoogle Scholar | PubMed | CAS | open url image1









1 Requests for the screening questions can be made to the primary author.