The Immediate Effects of Exposure Versus Response Prevention in the Treatment of Obsessive-Compulsive Disorder

1995 ◽  
Vol 23 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Ger P. J. Keijsers ◽  
Cees A. L. Hoogduin ◽  
Cas P. D. R. Schaap ◽  
Trix de Jong ◽  
Erica de Koning

Several empirical studies suggest that exposure in vivo and response prevention have a differential treatment effect on the complaints presented by patients with Obsessive-Compulsive Disorder (OCD). In the present study it was hypothesized that exposure in vivo would result in a greater decrease of obsessional fear, whereas response prevention would result in a greater decrease of rituals. Forty patients, diagnosed with OCD, participated in the study. Half of the patients received exposure in vivo alone, followed by response prevention alone, and half received response prevention alone, followed by exposure in vivo alone. No differential treatment effects between exposure in vivo alone and response prevention alone could be found, although ritualistic behaviour was less strongly affected by exposure in vivo following response prevention.

Author(s):  
Martin E. Franklin ◽  
Sarah G. Turk Karan

This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data on predictors and moderators of differential ERP outcomes. Contemporary ERP manuals emphasize the following core procedures: (1) psychoeducation; (2) hierarchy development; (3) in vivo and imaginal exposure; (4) response prevention; and (5) relapse prevention. The chapter looks at situations in which clinical circumstances dictate a deviation or modification of the protocol from the way these procedures are described in the manual or customarily implemented—being flexible while maintaining fidelity. Therapist experience appears to play a role in how comfortable clinicians are in being flexible, and how successful they are likely to be when they do so.


Author(s):  
Jenifer A. Viscusi ◽  
Monnica T. Williams

This chapter presents a case study of the treatment of sexual orientation obsessions in obsessive-compulsive disorder (also called SO-OCD or H-OCD for homosexual OCD). The case study includes information about the client background and case conceptualization of a male with upsetting sexual thoughts who was effectively treated using exposure and response prevention by the authors. Included are measures administered, Real-life examples of his exposure hierarchy, and sample imaginal exposures from the case that serve as realistic examples of what treatment may include. Additionally, this chapter includes additional detailed sample ideas of in vivo and imaginal exposures that can be used as part of treatment for SO-OCD for other clients.


Author(s):  
Andréa Litvin Raffin ◽  
Ygor Arzeno Ferrão ◽  
Fernanda Pasquoto de Souza ◽  
Aristides Volpato Cordioli

INTRODUÇÃO: As terapias comportamental e cognitivo-comportamental reduzem os sintomas do transtorno obsessivo-compulsivo em mais de 70% dos pacientes. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer fatores associados a esses desfechos poderia auxiliar numa melhor indicação do tratamento, incrementando sua eficácia. MÉTODO: Foram revisados trabalhos que investigaram fatores preditivos de resultados nos tratamentos do transtorno obsessivo-compulsivo, nas fontes PubMed, PsycINFO e LILACS. Termos utilizados na busca: predictive factors OR prediction AND obsessive-compulsive disorder AND exposure response prevention OR ritual prevention OR behav* therapy OR cognitive behav* therapy, resultando em 104 artigos. As referências dos artigos foram analisadas, possibilitando maior número de trabalhos revisados. Excluíram-se artigos que utilizaram apenas farmacoterapia e aqueles que não abordavam o tema, resultando em 29 artigos. DISCUSSÃO: As variáveis demográficas parecem exercer papel indireto, destacando-se sexo masculino e ausência de companheiro(a) como fatores de pior prognóstico. Maior gravidade e início precoce dos sintomas indicariam piores resultados. O transtorno esquizotípico comórbido é potencialmente negativo. Sintomas relacionados ao colecionismo e com conteúdo sexual/religioso indicam pior prognóstico. Maior nível de insight, motivação e colaboração com o tratamento são características favoráveis. Maior intensidade da melhora e a remissão completa são preditores para a não-recaída. CONCLUSÃO: A identificação de fatores preditores de resultados está longe de ser esclarecida. É possível que múltiplos fatores, cujas associações são complexas, atuem em conjunto. Os resultados podem depender de fatores não-específicos, ainda não abordados pelos estudos. A heterogeneidade do transtorno obsessivo-compulsivo e das pesquisas e o uso associado de medicamentos dificultam o estabelecimento de conclusões mais definidas.


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