Abstracts
Résumé
Le trouble obsessionnel-compulsif (TOC) est une condition invalidante pour laquelle l’exposition avec prévention de la réponse (EPR) constitue le traitement psychothérapeutique de première ligne. Malgré des données probantes solides, de nombreuses personnes atteintes n’ont pas accès à des interventions spécialisées, ce qui contribue à des trajectoires de soins longues, coûteuses et souvent peu efficaces. Ce cas décrit l’évolution d’une usagère de 66 ans présentant un TOC de plus de 40 ans, ayant participé à un programme intensif spécialisé en EPR offert dans un centre de santé universitaire. Les évaluations prétraitement, post-traitement et au suivi à 2 mois portaient sur la sévérité des symptômes, l’impact fonctionnel, l’acceptabilité du traitement, les attentes de changement et la disposition à tolérer l’inconfort associé aux expositions. Après 2 semaines d’intervention intensive, une diminution marquée de la sévérité du TOC, une amélioration significative du fonctionnement quotidien et une réduction notable des rituels ont été observées. Ces gains cliniques se sont maintenus et consolidés au suivi à 2 mois, en parallèle d’une confiance soutenue envers le traitement et d’un engagement durable dans les stratégies d’exposition. Ces résultats s’inscrivent dans la littérature démontrant l’efficacité des programmes intensifs, y compris pour des TOC de longue durée. Ce cas souligne l’importance de développer des services spécialisés pour le TOC au Québec et de former davantage de cliniciens aux approches fondées sur les données probantes. Il rappelle également que la chronicité du TOC n’est pas synonyme de résistance thérapeutique, mais plutôt d’un accès insuffisant à des interventions adéquates.
Mots-clés :
- trouble obsessionnel-compulsif,
- exposition avec prévention de la réponse,
- traitement intensif,
- étude de cas,
- services spécialisés
Abstract
Obsessive–compulsive disorder (OCD) is a disabling condition for which exposure and response prevention (ERP) is the first-line psychotherapeutic treatment. Despite strong evidence supporting its efficacy, many individuals with OCD do not receive specialized care, resulting in lengthy, costly, and often ineffective treatment trajectories. This case report describes a 66-year-old woman with a more than 40-year history of OCD who participated in an intensive, specialized ERP program delivered within a university hospital setting. Assessments conducted at pretreatment, post-treatment, and at a 2-month follow-up examined symptom severity, functional impairment, treatment acceptability, expectations for improvement, and willingness to tolerate discomfort associated with exposure-based work. Following two weeks of intensive intervention, the patient demonstrated a substantial reduction in OCD symptom severity, marked improvements in daily functioning, and a significant decrease in ritualistic behaviors. These clinical gains were maintained and further consolidated at the 2-month follow-up, alongside sustained confidence in the treatment approach and continued engagement in exposure-based strategies. These findings are consistent with evidence supporting the effectiveness of intensive ERP programs, including for individuals with longstanding OCD. This case underscores the critical need to expand access to specialized OCD services and to enhance clinician training in evidence-based interventions in Québec. More broadly, it illustrates that chronicity should not be equated with therapeutic resistance, but often reflects limited access to appropriate, specialized care.
Keywords:
- obsessive–compulsive disorder,
- exposure and response prevention,
- intensive treatment,
- case study,
- specialized services
Appendices
Bibliographie
- Abramowitz, J. S. (2006). The psychological treatment of obsessive—compulsive disorder. The Canadian Journal of Psychiatry, 51(7), 407-416.
- Capel, L. K., Ona, P. Z., Moller, C. et Twohig, M. P. (2023). An open trial of acceptance and commitment therapy with exposure and response prevention in an intensive outpatient setting for adults with OCD. Cognitive and Behavioral Practice, 30, 218-228. https://doi.org/10.1016/j.cbpra.2022.01.004
- Coste, J., Tarquinio, C., Rouquette, A., Montel, S. et Pouchot, J. (2020). Credibility/Expectancy Questionnaire--French Version (CEQ, QCA) [Database record]. APA PsycTests.
- Devilly, G. J. et Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73-86. https://doi.org/10.1016/S0005-7916(00)00012-4
- Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G. et Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory : Development and validation of a short version. Psychological Assessment, 14(4), 485-496. https://doi.org/10.1037/1040-3590.14.4.485
- Fontenelle, L. F., Nicolini, H. et Brakoulias, V. (2022). Early intervention in obsessive- compulsive disorder : From theory to practice. Comprehensive Psychiatry, 119, 152353.
- García-Soriano, G., Rufer, M., Delsignore, A. et Weidt, S. (2014). Factors associated with non- treatment or delayed treatment seeking in OCD sufferers : a review of the literature. Psychiatry Research, 220(1-2), 1-10.
- Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L. et Charney, D. S. (1989). The Yale-Brown obsessive compulsive scale : I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
- Hansen, B., Hagen, K., Öst, L.-G., Solem, S. et Kvale, G. (2018). The Bergen 4-day OCD treatment delivered in a group setting : 12-month follow-up. Frontiers in Psychology, 9, 369. https://doi.org/10.3389/fpsyg.2018.00639
- Huppert, J. D., Simpson, H. B., Nissenson, K. J., Liebowitz, M. R. et Foa, E. B. (2009). Quality of life and functional impairment in obsessive–compulsive disorder : a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depression and Anxiety, 26(1), 39-45.
- International OCD Foundation. (2025). America’s OCD care crisis : National findings on the failure of effective OCD treatment to reach patients. International OCD Foundation.
- Jónsson, H., Kristensen, M. et Arendt, M. (2015). Intensive cognitive behavioural therapy for obsessive-compulsive disorder : a systematic review and meta-analysis. Journal of Obsessive-Compulsive and related disorders, 6, 83-96.
- Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association canadienne des troubles anxieux and McGill University, Antony, M. M., Bouchard, S., Brunet, A., Flament, M., Grigoriadis, S., Mendlowitz, S., O’Connor, K., Rabheru, K., Richter, P. M., Robichaud, M. et Walker, J. R. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive–compulsive disorders. BMC Psychiatry, 14, S1. doi:10.1186/1471-244X -14— S 1— S1
- Kochar, N., Ip, S., Vardanega, V., Sireau, N. T. et Fineberg, N. A. (2023). A cost-of-illness analysis of the economic burden of obsessive-compulsive disorder in the United Kingdom. Comprehensive Psychiatry, 127, 152422.
- Kvale, G. et Hansen, B. (2014). Dissemination and intensifying evidence-based treatment for OCD : Norway is in the lead. Nordic Psychiatrist, 3, 14-15.
- Kvale, G., Hansen, B., Björgvinsson, T., Børtveit, T., Hagen, K., Haseth, S. et Öst, L. G. (2018). Successfully treating 90 patients with obsessive compulsive disorder in eight days : the Bergen 4-day treatment. BMC Psychiatry, 18, 1-9. https://doi.org/10.1186/s12888-018-1887-4
- Markarian, Y., Larson, M. J., Aldea, M. A., Baldwin, S. A., Good, D., Berkeljon, A., Murphy, T. K., Storch, E. A. et McKay, D. (2010). Multiple pathways to functional impairment in obsessive–compulsive disorder. Clinical Psychology Review, 30(1), 78-88.
- Marques, L., LeBlanc, N. J., Weingarden, H. M., Timpano, K. R., Jenike, M. et Wilhelm, S. (2010). Barriers to treatment and service utilization in an internet sample of individuals with obsessive–compulsive symptoms. Depression and anxiety, 27(5), 470-475.
- Milosevic, I., Levy, H. C., Alcolado, G. M. et Radomsky, A. S. (2015). The treatment acceptability/adherence scale : moving beyond the assessment of treatment effectiveness. Cognitive Behaviour Therapy, 44(6), 456-469.
- Mogan, C., Mogan, J., Foroughi, E., Addison, K., Bryan, J., Felmingham, K. et Yap, K. (2025). An outcome study of an intensive, out-patient exposure and response prevention therapy for obsessive compulsive disorder. The Cognitive Behaviour Therapist, 18, e21.
- Öst, L. G., Havnen, A., Hansen, B. et Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993-2014. Clinical Psychology Review, 40, 156-169.
- Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D. et Fineberg, N. A. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder : A systematic review and meta-analysis of randomised controlled trials. Comprehensive psychiatry, 106, 152223.
- Ruscio, A. M., Stein, D. J., Chiu, W. T. et Kessler, R. C. (2010). The epidemiology of obsessive- compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53-63. https://doi.org/10.1038/mp.2008.94
- Senter, M. S., Patel, S. R., Dixon, L. B., Myers, R. W. et Simpson, H. B. (2021). Defining and addressing gaps in care for obsessive-compulsive disorder in the United States. Psychiatric Services, 72(7), 784-793.
- Stobie, B., Taylor, T., Quigley, A., Ewing, S. et Salkovskis, P. M. (2007). “Contents may vary” : A pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35(3), 273-282.
- Williams, M. T., Osman, M., Kaplan, A. et Faber, S. C. (2024). Barriers to care for mental health conditions in Canada. PLOS Mental Health, 1(4), e0000065.
- Zermatten, A., Van der Linden, M., Jermann, F. et Ceschi, G. (2006). Validation of a French version of the Obsessive-Compulsive Inventory-Revised in a non-clinical sample. European Review of Applied Psychology/Revue Européenne de Psychologie Appliquée, 56(3), 151-155. https://doi.org/10.1016/j.erap.2005.07.003
- Zisler, E. M., Meule, A., Koch, S. et Voderholzer, U. (2024). Willingness to experience unpleasant thoughts, emotions, and bodily sensations at admission does not predict treatment outcome in inpatients with obsessive–compulsive disorder. Discover Mental Health, 4(1), 20.