cognitive-behavioral Therapy for Obsessive-compulsive Disorder

Two treatments have demonstrated efficacy in OCD, cognitive-behavioral therapy and pharmacotherapy with serotonin reuptake inhibitors (SRIs). In this article, which is the second in a three-part series, the authors discuss the role of exposure and ritual prevention (EX/RP) and cognitive therapy (CT) in the treatment of adults with OCD. They first describe EX/RP and review the studies that have demonstrated that it is a very efficacious treatment for OCD, both alone and in combination with pharmacotherapy with SRIs. The limitations of treatment with EX/RP are also described. These include high rates of patient refusal and drop-out, the continuing presence of some residual symptoms, the subsequent loss of treatment gains, possibly reduced effectiveness in certain clinical subtypes of OCD and in OCD accompanied by other comorbid psychiatric disorders (e.g., major depressive disorder), and the shortage of therapists trained in EX/RP for OCD. Recent research to develop even more effective modifications of EX/RP therapy for OCD are also described. Finally, the authors discuss when to refer patients with OCD for EX/RP treatment. In the second half of the article, the authors describe CT for OCD and discuss how helpful it may be for OCD. They conclude that there is no convincing evidence that any particular set of cognitive procedures is as good or better than potent EX/RP, but they note problems in the research, especially in disentangling the two types of therapy, since EX/RP often involves a number of CT procedures, while CT often includes some interventions that are closely related to EX/RP. The authors describe recent efforts to refine the cognitive theory of OCD and to determine when and how to use CT in OCD. They also describe presentations of OCD for which it may be helpful to consider a referral for CT. The next and final article in this series will cover psychopharmacological treatment for OCD.(Journal of Psychiatric Practice2000;6:59-68)