Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-r7xzm Total loading time: 0 Render date: 2024-03-28T15:10:03.578Z Has data issue: false hasContentIssue false

11 - Obsessive-Compulsive Disorder:

An Updated Cognitive Behavioral Approach

from Part Three - Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Associated Disorders

Published online by Cambridge University Press:  06 January 2022

Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

Cognitive behavioral therapy (CBT) and exposure and response prevention (E/RP) remain the treatments of choice for OCD, but for many clients outcomes are suboptimal. In the first part of this chapter, we present the CBT approach to OCD, alongside four promising areas to inform and refine current interventions, namely, optimizing E/RP with inhibitory learning principles; understanding complexity in OCD, differences in disgust, and harm avoidance; and using imagery rescripting for clients with intrusive images. In the second part, we provide an updated CBT and E/RP approach to OCD that integrates these areas into the standard assessment and treatment protocol. The approach emphasizes the importance of a clear developmental formulation with links of past relevant experiences to current OCD, and understanding the context, function, and unintended consequences of obsessions and compulsions. OCD measures and screening tools are introduced.

Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
, pp. 197 - 221
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27(4), 583600.Google Scholar
Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. The Canadian Journal of Psychiatry, 51(7), 407416.Google Scholar
Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., … & Adams, T. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22(1), 180.CrossRefGoogle ScholarPubMed
Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71(6), 1049.Google Scholar
Abramowitz, J. S., & Jacoby, R. J. (2014). Obsessive-compulsive disorder in the DSM-5. Clinical Psychology: Science and Practice, 21(3), 221235.Google Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.Google Scholar
Arch, J. J., & Abramowitz, J. S. (2015). Exposure therapy for obsessive-compulsive disorder: An optimizing inhibitory learning approach. Journal of Obsessive-Compulsive and Related Disorders, 6, 174182.Google Scholar
Arntz, A. (2011). Imagery rescripting for personality disorders. Cognitive and Behavioral Practice, 18(4), 466481.Google Scholar
Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715740.Google Scholar
Bouton, M. E. (1993). Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychological Bulletin, 114(1), 80.Google Scholar
Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52(10), 976986.Google Scholar
Bouton, M. E., Westbrook, R. F., Corcoran, K. A., & Maren, S. (2006). Contextual and temporal modulation of extinction: Behavioral and biological mechanisms. Biological Psychiatry, 60(4), 352360.Google Scholar
Calvocoressi, L., Lewis, B., Harris, M., & Trufan, S. J. (1995). Family accommodation in obsessive-compulsive disorder. The American Journal of Psychiatry, 152(3), 441.Google Scholar
Clark, D. A., & Radomsky, A. S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 265268.Google Scholar
Coughtrey, A. E., Shafran, R., Lee, M., & Rachman, S. (2013). The treatment of mental contamination: A case series. Cognitive and Behavioral Practice, 20(2), 221231.Google Scholar
Craske, M. G., Liao, B., Brown, L., & Vervliet, B. (2012). Role of inhibition in exposure therapy. Journal of Experimental Psychopathology, 3(3), 322345.Google Scholar
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 1023.Google Scholar
Duncko, R., & Veale, D. (2016). Changes in disgust and heart rate during exposure for obsessive compulsive disorder: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 51, 9299.Google Scholar
Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stout, R., & Rasmussen, S. A. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry, 47(4), 270275.CrossRefGoogle ScholarPubMed
Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., Atala, K. D., & Rasmussen, S. A. (1998). The brown assessment of beliefs scale: Reliability and validity. American Journal of Psychiatry, 155(1), 102108.Google Scholar
Fineberg, N. A., Hengartner, M. P., Bergbaum, C., Gale, T., Rössler, W., & Angst, J. (2013). Remission of obsessive-compulsive disorders and syndromes: Evidence from a prospective community cohort study over 30 years. International Journal of Psychiatry in Clinical Practice, 17(3), 179187.Google Scholar
Flessner, C. A., Freeman, J. B., Sapyta, J., Garcia, A., Franklin, M. E., March, J. S., & Foa, E. (2011). Predictors of parental accommodation in pediatric obsessive-compulsive disorder: Findings from the Pediatric Obsessive-Compulsive Disorder Treatment Study (POTS) trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(7), 716725. https://doi.org/10.1016/j.jaac.2011.03.019Google Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485.Google Scholar
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20.Google Scholar
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., … & Schmidt, A. B. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151161.Google Scholar
Frost, R. O., Steketee, G., Cohn, L., & Griess, K. (1994). Personality traits in subclinical and non-obsessive-compulsive volunteers and their parents. Behaviour Research and Therapy, 32(1), 4756.Google Scholar
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … & Charney, D. S. (1989). Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Archives of General Psychiatry, 46, 10061011.Google Scholar
Hollander, E., & Benzaquen, S. D. (1996). Is there a distinct OCD spectrum? CNS Spectrums, 1(1), 1726.Google Scholar
Hollander, E., Stein, D. J., Kwon, J. H., Rowland, C., Wong, C. M., Broatch, J., & Himelein, C. (1997). Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectrums, 2(10), 1625.CrossRefGoogle Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593602.Google Scholar
Ludvik, D., Boschen, M. J., & Neumann, D. L. (2015). Effective behavioural strategies for reducing disgust in contamination-related OCD: A review. Clinical Psychology Review, 42, 116129.Google Scholar
Mason, E. C., & Richardson, R. (2010). Looking beyond fear: The extinction of other emotions implicated in anxiety disorders. Journal of Anxiety Disorders, 24(1), 6370.CrossRefGoogle ScholarPubMed
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., … & Veale, D. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research, 225(3), 236246.Google Scholar
Melli, G., Chiorri, C., Carraresi, C., Stopani, E., & Bulli, F. (2015). The two dimensions of contamination fear in obsessive-compulsive disorder: Harm avoidance and disgust avoidance. Journal of Obsessive-Compulsive and Related Disorders, 6, 124131.Google Scholar
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 3341.Google Scholar
Olatunji, B. O., Sawchuk, C. N., de Jong, P. J., & Lohr, J. M. (2007). Disgust sensitivity and anxiety disorder symptoms: Psychometric properties of the disgust emotion scale. Journal of Psychopathology and Behavioral Assessment, 29(2), 115124.CrossRefGoogle Scholar
Olatunji, B. O., Wolitzky-Taylor, K. B., Willems, J., Lohr, J. M., & Armstrong, T. (2009). Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: An analogue study. Journal of Anxiety Disorders, 23(1), 118123.Google Scholar
Öst, L.-G., Havnen, A., Hansen, B., & 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, 156169.Google Scholar
Pinto, A., Van Noppen, B., & Calvocoressi, L. (2013). Development and preliminary psychometric evaluation of a self-rated version of the Family Accommodation Scale for Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive and Related Disorders, 2(4), 457465.Google Scholar
Rachman, S. (1994). Pollution of the mind. Behaviour Research and Therapy, 2(3), 311314.Google Scholar
Rachman, S. (2005). Vancouver Obsessional Compulsive Inventory Mental Contamination Scale (VOCI-MC). Rachman Lab.Google Scholar
Rachman, S. (2006). The fear of contamination: Assessment & treatment. Oxford University Press.CrossRefGoogle Scholar
Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304311.Google Scholar
Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233248.Google Scholar
Rachman, S., Shafran, R., Radomsky, A. S., & Zysk, E. (2011). Reducing contamination by exposure plus safety behaviour. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 397404.Google Scholar
Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., … & Wong, W. (2014). Part 1: You can run but you can’t hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269279.Google Scholar
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008). Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clinical Psychology Review, 28(8), 13101325.Google Scholar
Rosario, M. C., Prado, H. S., Borcato, S., Diniz, J. B., Shavitt, R. G., Hounie, A. G., … & Perin, E. A. (2009). Validation of the University of São Paulo sensory phenomena scale: Initial psychometric properties. CNS Spectrums, 14(6), 315323.Google Scholar
Rufer, M., Fricke, S., Moritz, S., Kloss, M., & Hand, I. (2006). Symptom dimensions in obsessive-compulsive disorder: Prediction of cognitive-behavior therapy outcome. Acta Psychiatrica Scandinavica, 113(5), 440446.Google Scholar
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29S52.Google Scholar
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., … & Thorpe, S. (2000). Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy, 38(4), 347372.Google Scholar
Schienle, A., Stark, R., & Vaitl, D. (2001). Evaluative conditioning: A possible explanation for the acquisition of disgust responses? Learning and Motivation, 32(1), 6583.Google Scholar
Sookman, D. (2015). Specialized cognitive behavior therapy for obsessive compulsive disorder: An expert clinician guidebook. Routledge.Google Scholar
Sookman, D., & Fineberg, N. A. (2015). Specialized psychological and pharmacological treatments for obsessive-compulsive disorder throughout the lifespan: A special series by the Accreditation Task Force (ATF) of the Canadian Institute for Obsessive Compulsive Disorders (CIOCD). Psychiatry Research, 227(1), 7477.Google Scholar
Soomro, G. M., Altman, D., Rajagopal, S., & Oakley-Browne, M. (2008). Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). The Cochrane Database of Systematic Reviews, (1), CD001765.Google Scholar
Speckens, A., Ehlers, A., Hackmann, A., Ruths, F., & Clark, D. (2007). Intrusive memories and rumination in patients with post-traumatic stress disorder: A phenomenological comparison. Memory, 15(3), 249257.CrossRefGoogle ScholarPubMed
Stewart, S. E., Beresin, C., Haddad, S., Egan Stack, D., Fama, J., & Jenike, M. (2008). Predictors of family accommodation in obsessive-compulsive disorder. Annals of Clinical Psychiatry, 20(2), 6570.Google Scholar
Storch, E. A., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., Murphy, T. K., & Goodman, W. K. (2007). Florida Obsessive-Compulsive Inventory: Development, reliability, and validity. Journal of Clinical Psychology, 63(9), 851859.Google Scholar
Sündermann, O., & Veale, D. (2017). Complexity in obsessive-compulsive and body dysmorphic disorder: A functional approach to complex difficulties. The Cognitive Behaviour Therapist, 10.CrossRefGoogle Scholar
Taylor, S., & Jang, K. L. (2011). Biopsychosocial etiology of obsessions and compulsions: An integrated behavioral-genetic and cognitive-behavioral analysis. Journal of Abnormal Psychology, 120(1), 174.Google Scholar
Thompson-Hollands, J., Abramovitch, A., Tompson, M. C., & Barlow, D. H. (2015). A randomized clinical trial of a brief family intervention to reduce accommodation in obsessive-compulsive disorder: A preliminary study. Behavior Therapy, 46(2), 218229.Google Scholar
Tolin, D. F., Maltby, N., Diefenbach, G. J., Hannan, S. E., Worhunsky, P., et al. (2004). Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: A wait-list-controlled open trial. Journal of Clinical Psychiatry, 65(7), 922931.Google Scholar
van Oppen, P., van Balkom, A. J., de Haan, E., & van Dyck, R. (2005). Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive-compulsive disorder: A 5-year follow-up. The Journal of Clinical Psychiatry, 66(11), 14151422.Google Scholar
Veale, D. (2007). Cognitive-behavioural therapy for obsessive-compulsive disorder. Advances in Psychiatric Treatment, 13(6), 438446.Google Scholar
Veale, D., Gilbert, P., Wheatley, J., & Naismith, I. (2014). A new therapeutic community: Development of a compassion-focussed and contextual behavioural environment. Clinical Psychology & Psychotherapy, 22(4), 285303.Google Scholar
Veale, D., Page, N., Woodward, E., & Salkovskis, P. (2015). Imagery rescripting for obsessive compulsive disorder: A single case experimental design in 12 cases. Journal of Behavior Therapy and Experimental Psychiatry, 49, Part B, 230236.Google Scholar
Vervliet, B., Craske, M. G., & Hermans, D. (2013). Fear extinction and relapse: State of the art. Annual Review of Clinical Psychology, 9, 215248.Google Scholar
Woody, S. R., & Teachman, B. A. (2000). Intersection of disgust and fear: Normative and pathological views. Clinical Psychology: Science and Practice, 7(3), 291311.Google Scholar
Zysk, E., Shafran, R., & Williams, T. (2018). The origins of mental contamination. Journal of Obsessive-Compulsive and Related Disorders, 17, 38.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×