Over 90% of German adults with OCD say they would do exposure therapy, and half of those with CBT had it
- In an anonymous online survey of 276 adults with OCD in Germany (Dec 2023 to May 2024), the mean delay to seeking psychotherapy was 5.15 years (SD 6.88) and the mean delay to recognising the symptoms as OCD was 5.58 years (SD 7.16). Before reaching psychotherapy, respondents had contacted a median of 5 professionals (mean 8.94, SD 11.99, range 1–99).
- 74.3% had ever received CBT. Of the 211 who had received CBT, 49.5% reported therapist-guided exposure and response prevention (ERP) at some point.
- Over 90% said they would use CBT with ERP much or very much if there were no external barriers. The authors report that external barriers contributed more to not receiving ERP than internal ones, and that fear of exposure was named by very few.
- Higher Y-BOCS scores went with higher ratings of four barriers to ERP: fear of ERP (rho = 0.23, p < 0.001), treatment too far away (rho = 0.22, p < 0.001), waiting times too long (rho = 0.14, p = 0.026) and the assumption that psychotherapy would not work (rho = 0.18, p = 0.005).
Bey and colleagues at University Hospital Bonn asked adults with OCD about the route to treatment. The survey was anonymous and online, open from December 2023 to May 2024, and 276 people took part: 72.1% women, mean age 32.72 years (SD 9.28). 80.1% reported a diagnosis from a health professional; the rest had diagnosed themselves.
Years and contacts before treatment
On average 5.15 years (SD 6.88) passed before respondents sought psychotherapy, and 5.58 years (SD 7.16) before they recognised their symptoms as OCD. Those who reached psychotherapy had first contacted a median of 5 professionals; the mean was 8.94 (SD 11.99), with a range from 1 to 99.
Therapy received
74.3% reported ever receiving outpatient CBT. Among the 211 who had received CBT in either setting, 49.5% reported therapist-guided ERP, and 71.2% reported ERP assigned as homework. A median of 2 therapies came before the one in which they received ERP.
Barriers, as rated by respondents
Barriers to exposure-based treatment were rated on a scale from 1 (none) to 5 (very large). Lack of knowledge about treatment options and contact points was the most common one. The authors report that external barriers weighed more than internal ones; the most common internal barrier was the wish to handle the problem alone, followed by shame. Over 90% said they would use CBT with ERP much or very much if no external barriers stood in the way.
More severe symptoms went with higher ratings for four barriers: fear of ERP (rho = 0.23, p < 0.001), treatment too far away (rho = 0.22, p < 0.001), waiting times too long (rho = 0.14, p = 0.026) and the assumption that psychotherapy would not work (rho = 0.18, p = 0.005). Fear of ERP was named by few, yet it rose with severity. The waiting figure rates how much waiting held respondents back; it is not a measured wait.
In this sample, stated willingness was high: over 90% said they would do ERP if nothing stood in the way, and the barriers respondents named most were external.
This is a self-report survey of 276 people, recruited mostly through an OCD self-help platform and a clinic, so the sample may not represent all German adults with OCD. 19.9% of respondents had diagnosed themselves, and the Y-BOCS total score was calculated without one item because of a programming error. Barrier ratings are subjective and reflect perception, not measured waiting times or distances. The willingness figure is a stated preference, not observed uptake.