Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-25T11:22:48.340Z Has data issue: false hasContentIssue false

Current Issues in Behavior and Cognitive Therapy for Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  07 November 2014

Abstract

Exposure and response prevention (ERP), a form of behavior therapy, is widely recognized as the most effective psychological treatment for obsessive-compulsive disorder (OCD). Cognitive therapy (meaning rational emotive behavior therapy [REBT], or the Salkovskis model for this article) has received increased attention as an effective method for OCD treatment. These methods have renewed hope for patients suffering with what had long been thought to be a treatment refractory condition. Yet many important issues require further discussion and investigation. At the Second International Conference on OCD, which was held in Guadeloupe, February 14–16, 1996, the following issues were highlighted:

1. Which psychotherapies are effective in the treatment of OCD?

2. What psychological strategies may be used to increase patient motivation during treatment?

3. Are relapse prevention strategies necessary after improvement?

4. How do economic factors affect the use of behavior therapy? How is OCD treatment uniform or varying from specialty providers to mental health generalists to primary care physicians? How do self-administered and therapist-administered ERP compare?

5. How does the efficacy of ERP or cognitive therapy and pharmacotherapy (either alone or in combination) compare?

6. Is ERP effective for complex forms of OCD?

7. In OCD treatment, is medication compliance improved if ERP or cognitive therapy is also used, and vice versa? How does this affect relapse rates? In addition, can doses of medications be lowered with the addition of ERP or cognitive therapy?

8. What is known about the brain function and biological changes associated with ERP and cognitive therapy?

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 1996

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

1.Black, JL. Obsessive compulsive disorder: a clinical update. Mayo Clin Proc. 1992:67:266275.CrossRefGoogle ScholarPubMed
2.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed revised. Washington, DC: American Psychiatric Association; 1987.Google Scholar
3.Stanley, MA. Turner, SM. Current status of pharmacological and behavioral treatment of obsessive compulsive disorder. Behav Therapy. 1995:26:163186.CrossRefGoogle Scholar
4.Yaryura-Tobias, JA, Neziroglu, F.Obsessive-Compulsive Disorder: Pathogenesis-Diagnosis-Treatment. New York: Marcel Dekker; 1983.Google Scholar
5.Yaryura-Tobias, JA, Neziroglu, F. The Obsessive-Compulsive Spectrum Disorders. Washington, DC: American Psychiatric Press; 1996. In press.Google Scholar
6.Sketekee, G. Behavioral assessment and treatment planning with obsessive-compulsive disorder: a review emphasizing clinical application. Behav Therapy. 1994:24:613634.CrossRefGoogle Scholar
7.Boersma, K, den Hengst, S, Dekker, J, et al. Exposure and response prevention in the natural environment: a comparison with obsessive-compulsive patients. Behav Res Ther. 1976:14:1924.CrossRefGoogle ScholarPubMed
8.Boulougouris, JC, Basiakos, L. Prolonged flooding in cases with obsessive-compulsive neurosis. Behav Res Ther. 1973:11:227231.CrossRefGoogle ScholarPubMed
9.Emmelkamp, PM, Kraanen, J. Therapist-controlled exposure in-vivo: a comparison with obsessive-compulsive patients. Behav Res Ther. 1977;15:491495.CrossRefGoogle ScholarPubMed
10.Foa, EB, Goldstein, AJ. Continous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis. Behav Ther. 1978:9:821829.CrossRefGoogle Scholar
11.Marks, IM, Hodgson, R, Rachman, S. Treatment of obsessive-compulsive neurosis by in-vivo exposure: a two-year followup and issues in treatment. Br J Psychiatry. 1975:127:349364.CrossRefGoogle ScholarPubMed
12.Emmelkamp, PMG, Rabbie, D. Psychological treatment of obsessive compulsive disorder. In: Perris [INITIALS?], Biological Psychiatry. ed. Amsterdam: Elsevier; 1981.Google Scholar
13.Kasviskis, Y, Marks, IM. Clomipramine, self-exposure, and therapist-accompanied exposure in obsessive-compulsive ritualizers: two-year follow-up. J Anxiety Dis. 1988;2:291298.CrossRefGoogle Scholar
14.Mawson, D, Marks, IM, Ramm, L. Clomipramine and exposure for chronic obsessive-compulsive disorder: two-year follow-up and further findings. Br J Psychiatry. 1982;140:1118.CrossRefGoogle ScholarPubMed
15.Visser, S, Hoekstra, RJ, Emmelkamp, PMG. Follow-up study on behavioral treatment of obsessive-compulsive disorders. In: A, Fiegenbaum, W, Florin, I, Margraf, J, eds. Perspectives and Promises of Clinical Psychology. New York: Plenum Press; 1991.[CHAPTERPAGE NUMBERS?]Google Scholar
16.Marks, IM. Behavior psychotherapy in obsessive-compulsive disorders. Encephale. 1990:16:341346.Google ScholarPubMed
17.O'Sullivan, G, Noshirvani, H, Marks, I, et al. Six-year followup after exposure and clomipramine therapy for obsessive-compulsive disorder. J Clin Psychiatry. 1991:52:150155.Google ScholarPubMed
18Ball, S, Baer, L, Otto, M. Symptom subtypes of obsessive compulsive disorder in behavioral treatment studies: a quantitative review. Behav Res Ther. 1996:34:4752.CrossRefGoogle ScholarPubMed
19.Ellis, A. Reason and Emotion in Psychotherapy. New York: Lyle Stuart Inc; 1962.Google Scholar
20.Ellis, A. Rational emotive behavioral therapy approaches to obsessive-compulsive disorder (OCD). J Rational-Emotive Cognitive Behav Therapy. 1994:12:121141.CrossRefGoogle Scholar
21.Neziroglu, F, Yaryura-Tobias, JA. Over and Over Again: Understanding Obsessive-Compulsive Disorder. New York: Lexington Books; 1995.Google Scholar
22.Salkovskis, PM. Obsessional-compulsive problems: a cognitive-behavioral analysis. Behav Res Ther. 1985;23:571583.CrossRefGoogle Scholar
23.van Oppen, P, Arntz, A. Cognitive therapy for obsessive compulsive disorder. Behav Res Ther. 1994:32:7987.CrossRefGoogle ScholarPubMed
24.Freeston, MH, Ladouceur, R, Gagnon, F, Thibodeau, N. Belief about obsessional thought. J Psychopathology Assessment. 1993:15:121.CrossRefGoogle Scholar
25.Emmelkamp, PMG, Visser, S, Hoekstra, RJ. Cognitive therapy vs. exposure in vivo in the treatment of obsessive compulsives. Cognitive Therapy Research. 1988:12:103114.CrossRefGoogle Scholar
26.Neziroglu, F, Neuman, J. Three treatment approaches for obsessions. J Cognitive Psychotherapy: An International Quarterly. 1990:4:377392CrossRefGoogle Scholar
27.Emmelkamp, P, Beens, H. Cognitive therapy with obsessive-compulsive disorder: a comparative evaluation. Behav Res Ther. 1991:29:293300.CrossRefGoogle ScholarPubMed
28.van Oppen, P, De Haan, E, Van Balkom, A, Spinhoven, P, Hoogduin, K, van Dyke, R. Cognitive therapy and exposure in vivo in the treatment of obssessive compulsive disorder. Behav Res Ther. 1995:33:379390.CrossRefGoogle Scholar
29.James, IA, Blackburn, I. Cognitive therapy with obsessive-compulsive disorder. Br J Psychiatry. 1995:166:444450.CrossRefGoogle ScholarPubMed
30.Weissman, M, Markowitz, J. Interpersonal psychotherapy current status. Arch Gen Psychiatry. 1994:51:599606.CrossRefGoogle ScholarPubMed
31.Foa, E, Kozak, MJ, Steketee, GS, McCarthy, PR. Treatment of depressive and obsessive-compulsive symptoms in obsessive compulsive disorder by imipramine and behavior therapy. Br J Clin Psychol. 1992:31:279292.CrossRefGoogle Scholar
32.Claire, JB. The forbidden zone: managing resistance in patients with obsessive compulsive disorders. The Behavior Therapist. 1991;14:7576.Google Scholar
33.March, JS, Mulle, K. Manualized cognitive-behavioral psychotherapy for obsessive compulsive disorder in childhood: a preliminary single case study. J Anxiety Dis. 1995:9:175184.CrossRefGoogle Scholar
34.Pato, MT, Zohar-Kadouch, R, Murphy, DL. Return of symptoms after discontinuation of clomipramine in patients with obsessive compulsive disorder. Am J Psychiatry. 1988;145:15211525.Google ScholarPubMed
35.Emmelkamp, PMG, Kloek, J, Blaauw, E. Obsessive compulsive disorders. In: Wilson, PH, ed. Principles and Practice of Relapse Prevention. New York: Guilford; 1992.Google Scholar
36.Hiss, H, Foa, EB, Kozak, MJ. A relapse prevention program for the treatment of obsessive-compulsive disorder. J Consult Clin Psychol. 1994;62:801803.CrossRefGoogle ScholarPubMed
37.McKay, D, Todaro, J, Neziroglu, F, Yaryura-Tobias, JA. Evaluation of a naturalistic maintenance program in the treatment of obsessive-compulsive disorder: a preliminary investigation. J Anxiety Dis. 1996:10:211217.CrossRefGoogle Scholar
38.Steketee, G. Social support and treatment outcome of obsessive compulsive disorder: a nine month follow-up. Behav Psychotherapy. 1993:21:8195.CrossRefGoogle Scholar
39.Marlatt, GA, Gordon, LM. Relapse Prevention: Maintenance Strategies in Addictive Behavior Change. New York: Guilford Press; 1985.Google Scholar
40.Broatch, JW. Equality now. Obsessive Compulsive Disorder Newsletter. 1995;9(5):1Google Scholar
41.Lelliott, FT, Montero, WO. Drug treatment of obsessive-compulsive disorder. Drugs. 1986:31:7580.CrossRefGoogle ScholarPubMed
42.Abel, J. Exposure with response prevention and serotonergic antidepressants in the treatment of obsessive compulsive disorder: a review and implication for interdisciplinary treatment. Behav Res Ther. 1993:31:463478.CrossRefGoogle ScholarPubMed
43.Turner, SM, Beidel, DC. Treating Obsessive-Compulsive Disorder. New York: Pergamon Press; 1988.Google Scholar
44.Krone, KP, Himle, JA, Nesse, RM. A standardized behavioral group treatment program for obsessive-compulsive disorder: preliminary outcomes. Behav Res Ther. 1991:29:627631.CrossRefGoogle ScholarPubMed
45.Emmelkamp, PMG, van den, Heuvell C, Ruphan, M, Sanderman, R. Home based treatment of obsessive-compulsive patients: intersession interval and therapist involvement. Behav Res Ther. 1989:27:8993.CrossRefGoogle ScholarPubMed
46.Marks, IM, Lelliot, Basoglu M, et al. Clomipramine self-exposure and therapist-aided exposure for obsessive-compulsive rituals. Br J Psychiatry. 1988:152:522534.CrossRefGoogle ScholarPubMed
47.Cottraux, J, Mollard, E, Bovard, M, et al. A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol. 1990;5:1730.CrossRefGoogle ScholarPubMed
48.van Balkom, A, Vermeulen, A, van Dyck, R, Nauta, M, Vorst, H. A meta-analysis on the treatment of obsessive-compulsive disorder: a comparison of antidepressants, behavior, and cognitive therapy. Clin Psych Review. 1994;14(5):359381.CrossRefGoogle Scholar
49.Foa, EB, Kozak, MJ, Liebowitz, M, et al. Treatment of obsessive-compulsive disorder by behavior therapy, clomipramine, double-blind controlled trial. Presented at the 27th Annual Convention of the Association for Advancement of Behavior Therapy; November, 1993; Atlanta, GA.Google Scholar
50.Baer, L, Jenike, MA. Personality disorders in obsessive compulsive disorders. Psychiair Clin North Am. 1992;15:803812.CrossRefGoogle Scholar
51.McKay, D, Neziroglu, F, Todaro, J, Yaryura-Tobias, JA. Changes in personality disorders following behavior therapy for obsessive compulsive disorder. J Anxiety Dis. 1996;10(1):4757.CrossRefGoogle Scholar
52.Stein, DJ, Hollander, E, DeCaria, CM. Personality disorders and obsessive compulsive disorder. In: Hollander, E, Zohar, J, Marazziti, D, Olivier, B, eds. Current Insights in Obsessive Compulsive Disorder. [CITY=CHICHESTER?] England: John Wiley&Sons; 1994:4151.Google Scholar
53.Pfohl, B, Black, DW, Noyes, R, Coryell, WH, Barrash, J. Axis 1 and Axis II comorbidity findings: implications for validity in personality disorders. In: Oldham, JM, ed. New Perspectives on Diagnostic Validity. Washington DC: American Psychiatric Press; 1991:147161.Google Scholar
54.Steketee, G. Personality traits and disorders in obsessivecompulsives. J Anxiety Dis. 1990:4:351364.CrossRefGoogle Scholar
55.Minichiello, WE, Baer, L, Jenike, MA. Schizotypal personality disorder: a poor prognostic indicator for behavior therapy in the treatment of obsessive-compulsive disorder. J Anxiety Dis. 1987:1:273276.CrossRefGoogle Scholar
56.Jenike, MA, Rauch, SL. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry. 1994;55(3):1117.Google ScholarPubMed
57.Yaryura-Tobias, JA, Anderson, M, Neziroglu, F. Organicity in obsessive compulsive Disorder. Bio Psychiatry. In press.Google Scholar
58.Rasmussen, SA, Eisen, JL. The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry. 1992;53(suppl 4):410.Google ScholarPubMed
59.Crino, D, Andrews, D. Obsessive-compulsive disorder and axis 1 comorbidity. J Anxiety Dis. 1996;10:3746.CrossRefGoogle Scholar
60.Hollander, E, ed. Obsessive Compulsive Disorders. Washington DC: American Psychiatric Press; 1993.Google Scholar
61.Rachman, S, Cobb, J, Grey, B, et al. The behavioral treatment of obsessive-compulsive disorders with and without clomipramine. Behav Res Ther. 1979:17:467478.CrossRefGoogle ScholarPubMed
62.Pigott, TA, Pato, MT, Bernstein, SE, et al. Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1990:47:926932.CrossRefGoogle ScholarPubMed
63.Solyom, L, Sookman, D. The effectiveness of four behavior therapies in the treatment of obsessive neurosis. In: Boulougouris, JC, Rabqulas, AD, eds. The Treatment of Phobic and Obsessive-Compulsive Disorders. London: Pergamon Press; 1976.Google Scholar
64.Cottraux, J, Gerard, D, Cinotti, L, et al. A controlled positron emission tomography study of obsessive and neutral auditory stimulation in obsessive compulsive disorder with checking rituals. Psychiatry Res. 1996:60:101112.CrossRefGoogle ScholarPubMed
65.Hoehn-Saric, R, Benkelfat, C. Structural and functional brain imaging in obsessive compulsive disorder. In: Hollander, E, Zohar, J, Marazitti, D, Olivier, B, eds. Current Insights in Obsessive Compulsive Disorder. Chichester, England: John Wiley & Sons; 1994:183211.Google Scholar
66.Baxter, LR Jr, Schwartz, JM, Bergman, KS, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1994:49:681689.CrossRefGoogle Scholar
67.Neziroglu, F, Steele, J, Yaryura-Tobias, JA, et al. Effect of behavior therapy on serotonin level in obsessive compulsive disorder. In: Stefanis, CN, Rasavillas, CR, Soladatos, , eds. Psychiatry: A World Perspective, Vol.3. Amsterdam: Elsevier Science Publishers BV (Biomedical Division); 1990.Google Scholar
68.Schwartz, JM, Stoessel, PW, Baxter, LR Jr, Martin, KM, Phelps, ME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996:53:109113.CrossRefGoogle ScholarPubMed