Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy, 43, 1559-1576

Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 2B5.
Behaviour Research and Therapy (Impact Factor: 3.85). 01/2006; 43(12):1559-76. DOI: 10.1016/j.brat.2004.11.012
Source: PubMed

ABSTRACT The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.

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    • "Based on cognitive theories and previous research (Emmelkamp et al., 2002; Whittal et al., 2005), it was hypothesized that appraisals will change significantly following treatment and that this change would be significantly related to change in obsessive-compulsive symptoms. This study extends previous studies by using a larger OCD sample and by exploring possible differences in thought content in relation to appraisal and symptoms when delivering CBT for OCD. "
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    ABSTRACT: A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients with autogenous thoughts who appraised their intrusions as more important than others. OCD is heterogeneous regarding thought content and strength of appraisals but can be quite homogeneous in terms of CBT treatment response. Also, and in line with cognitive theory, recovery from OCD is associated with changes in appraisals.
    Journal of Cognitive Psychotherapy 05/2015; 29(2). DOI:10.1891/0889-8391.29.2.106
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    • "Third, in laboratory studies, experimental manipulations of these beliefs lead to changes in OC symptoms such as compulsive checking (e.g., Ladouceur et al., 1995). Fourth, treatment studies have shown that the beliefs decline over the course of successful cognitive-behavioral therapy for OCD (e.g., Anholt et al., 2010; Whittal, Thordarson, & McLean, 2005), which is what would be expected if these beliefs were among the engines driving the disorder. Fifth, there is evidence that these beliefs have some degree of specificity to OC symptoms. "
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    ABSTRACT: Contemporary cognitive models of obsessive-compulsive disorder (OCD) emphasize the importance of various types of dysfunctional beliefs in contributing to OC symptoms, such as beliefs about excessive personal responsibility, perfectionism, and intolerance for uncertainty. The present study seeks to further our understanding of the role of these beliefs by identifying the common profiles of such beliefs, using profile analysis via multidimensional scaling (PAMS). In Study 1, a large student sample (N=4079) completed the 44-item obsessive beliefs questionnaire. One major profile, control of thoughts and perfectionism, was extracted. Study 2 examined profiles of the 87-item obsessive beliefs questionnaire in people with obsessive-compulsive disorder (OCD; n=398), other anxiety disorders (n=104), and a sample of undergraduate students (n=285). Inflated responsibility was a prominent subscale in the profiles of all three groups. Only control over thoughts was a unique subscale in the profile obtained for the OCD group, with this group having lower scores compared to the other groups. The results suggest that while inflated responsibility is a significant subscale in the profile of individuals with OCD, it is not a unique contributor; instead, control over thoughts is unique to OCD. The data, as well as recent research investigating obsessive beliefs, suggest the need to revise the contemporary cognitive model of OCD.
    Journal of anxiety disorders 03/2014; 28(4):352-357. DOI:10.1016/j.janxdis.2014.03.004 · 2.68 Impact Factor
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    • "The success of cognitive and behavioural treatments that include ERP has been demonstrated across numerous studies in both adult [17] and pediatric [18] OCD populations. However, individuals over the age of 65 years have generally been excluded from these treatment trials [19] [20] [21]. As such, the generalisability of these methods to elderly populations remains largely undocumented [22]. "
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    ABSTRACT: Obsessive compulsive disorder (OCD) is one of the most frequently occurring psychiatric conditions in older adults. While exposure and response prevention (ERP) is considered the most effective psychological treatment for children and adults with OCD, research investigating its effectiveness for older adults is scarce. This clinical case study investigates the effectiveness of ERP in an 80-year-old man with a 65-year history of OCD. The client received 14 individual, 50-minute ERP treatment sessions. Clinician-based Y-BOCS scores reduced by 65% from 20 (moderate) at pretreatment to 7 (subclinical) at 7-month posttreatment followup. OCI-R total scores reduced by 45% from 38 at baseline to 21 at 7-month follow-up. Despite his long history of the disorder, ERP was effective and well tolerated. The application of ERP for older adults with OCD, including age-specific modifications that may be required for this treatment approach, is discussed.
    12/2012; 2012:394603. DOI:10.1155/2012/394603
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