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?