A regional mental health service is redesigning care for people with obsessive compulsive disorder. Its review finds that some people prefer medication, som...

(a) SSRI antidepressant medication / selective serotonin reuptake inhibitor. [1]
(b) The person is gradually/directly exposed to a feared stimulus or situation [1]. They are supported to avoid the usual compulsive response [1]. Anxiety is expected to reduce over time without completing the compulsion [1].
(c) A genetic explanation states that inherited genes can create vulnerability to OCD [1]. Higher concordance in identical than non-identical twins would support a genetic contribution [1]. A biochemical explanation proposes atypical serotonin functioning [1], which may affect mood/anxiety regulation and contribute to obsessive or compulsive characteristics [1].
(d) Indicative content, award up to 17 marks: Biological treatments can be relatively quick to prescribe and may reduce symptoms sufficiently for people to engage in work, social life or psychological therapy [1]. SSRIs have some research support because altering serotonin availability can improve symptoms for some people [1]. Medication can be accessible where trained therapists and lengthy therapy appointments are limited [1]. However, an association between serotonin and OCD does not show that low serotonin is the sole cause [1]. Medication may produce side effects such as nausea, sleep disruption or sexual difficulties [1], reducing adherence [1]. Symptoms may return when medication stops if the person has not learned new coping behaviour [1]. Biological accounts can be reductionist because they overlook traumatic experiences, learning history, cognitions and social factors [1].

ERP directly targets compulsive behaviour by exposing the person to feared cues and preventing rituals [1]. It has face validity because the person learns that anxiety can decline without washing, checking or arranging [1]. This may provide longer-lasting skills that can be used independently after therapy [1]. Cognitive behavioural therapy can also challenge catastrophic beliefs and inflated responsibility that maintain obsessions [1]. Yet ERP can initially be distressing, and some people may discontinue it or refuse exposure tasks [1]. It requires time, trained clinicians and regular attendance, so access may be unequal [1]. Therapist skill and the quality of the therapeutic relationship can affect outcomes [1]. A narrow psychological explanation may also fail to address biological vulnerability or severe depression that makes therapy participation difficult [1].

A combined approach is often most appropriate because medication may lower anxiety enough for a person to tolerate ERP [1], while ERP teaches strategies that address compulsive behaviour and beliefs [1]. Treatment should be chosen collaboratively, considering symptom severity, previous response, side effects, preference, risk and practical circumstances [1]. The service should avoid claiming that one approach works for every person because OCD is heterogeneous and research samples may not represent all cultural and age groups [1]. A justified conclusion that a flexible combined and individualised plan is preferable, with monitoring and review, gains the final evaluative credit [1].