January 21, 2009


THE NEED for increased resources to be invested in the training of cognitive behavioural therapists (CBTs) is essential for the proper treatment of anxiety disorders such as obsessive compulsive disorder (OCD) in Irish patients.

This is according to consultant psychiatrist and director of the anxiety programme at St Patrick’s Hospital in Dublin, Dr Michael McDonough, who says that treatment with CBT provides the best long-term results for OCD patients.

Obsessive compulsive disorder (OCD) is the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours.

It is estimated to affect 2-3 per cent of the Irish population and tends to be a chronic or lifelong problem with onset generally in the teens and early adulthood.

“OCD is a complex disorder, one of the anxiety disorders. It was traditionally associated with the milder end of mental health problems but in truth it can be quite disabling and can restrict a sufferer’s quality of life in functioning in so many ways,” said Dr McDonough.

Before the arrival of modern medications and CBT, OCD was generally thought to be untreatable.

However, the good news, according to Dr McDonough, is that the disorder – particularly in the mild and moderate category – responds very well to treatment so there is hope for sufferers out there who have not yet gone for help.

While St Patrick’s has a well- developed CBT department and runs an OCD assessment clinic for private patients from all around the State, Dr McDonough said access to CBT therapists could be “a bit variable” for patients.

“It’s the dilemma of drug treatment versus cognitive behavioural therapy. While CBT has the best long-term results for OCD sufferers, drug therapy can also be very helpful and in a service where there is a shortage of therapists, there tends to be a reliance on drug therapy as waiting lists for CBT are so long.”

Dr McDonough said St Patrick’s Hospital was working with Trinity College Dublin and the Health Service Executive (HSE) to train more CBT therapists and he highlighted the need for more investment in this area by the HSE, despite the current challenging financial climate.

“I do know there are some good therapists out there working in the HSE, but the problem is there are not enough doing CBT work,” he said.

While some patients responded very well to treatment, Dr McDonough said that response could be partial or poor in other patients and they could be left with residual symptoms, especially where the OCD was complicated by another problem such as depression or drug addiction.

“These severe, resistant cases tend to be the ones referred to our service or for secondary care around the country. These patients require treatment by a multidisciplinary team led by a consultant psychiatrist for the best results. There are specialist OCD inpatient units in the UK but we are the only one in Ireland for more severe resistant cases.”