Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Study of a Veteran With Violent Intrusive Thoughts

Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence. Upon reengagement in treatment, the therapist provided ERP in 34 sessions over 14 months, with 15 sessions via video telehealth to home. The patient used the OCD Workbook as a resource throughout treatment. The patient developed a hierarchy of target obsessions and rituals with associated subjective units of distress; completed exposures, beginning with lower-level items; and wrote imaginal scripts. He also received zolpidem for insomnia and venlafaxine for anxiety and depression. His scores on the nine-item Patient Health Questionnaire and Yale Brown Obsessive-Compulsive Scale decreased significantly.

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Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of "Daniel"

Pragmatic Case Studies in Psychotherapy ◽

10.14713/pcsp.v15i1.2043 ◽

2019 ◽

Vol 15 (1) ◽

pp. 1

Author(s):

Alexander M.B. Tice

Keyword(s):

Obsessive Compulsive Disorder ◽

Response Prevention ◽

Exposure And Response Prevention ◽

Case Study Method ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Positive Treatment ◽

Evidenced Based ◽

Manualized Protocol

Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.

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Treating Sexual Orientation Obsessions

Sexual Obsessions in Obsessive-Compulsive Disorder ◽

10.1093/med-psych/9780190624798.003.0006 ◽

2019 ◽

pp. 163-206

Author(s):

Jenifer A. Viscusi ◽

Monnica T. Williams

Keyword(s):

Sexual Orientation ◽

Obsessive Compulsive Disorder ◽

Real Life ◽

Response Prevention ◽

Case Conceptualization ◽

Exposure And Response Prevention ◽

Obsessive Compulsive ◽

Compulsive Disorder

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.

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Utilizing Exposure and Response Prevention to Address Poor Insight in Obsessive-Compulsive Disorder

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.33.3.213 ◽

2019 ◽

Vol 33 (3) ◽

pp. 213-227 ◽

Cited By ~ 1

Author(s):

Rachel R. Middleton ◽

Dianne M. Hezel

Keyword(s):

Obsessive Compulsive Disorder ◽

Response Prevention ◽

Exposure And Response Prevention ◽

Comorbid Depression ◽

Obsessive Compulsive ◽

Illness Onset ◽

Compulsive Disorder ◽

Compulsive Behaviors ◽

Insight Into

Studies indicate that approximately 9%–30% of adults diagnosed with obsessive-compulsive disorder have poor insight into their symptoms. That is, they fail to recognize the excessiveness or irrationality of the obsessive thoughts or their compulsive behaviors. Poor insight in OCD is associated with more severe symptoms, earlier age of illness onset, longer illness duration, and higher rates of comorbid depression. Moreover, some studies have also reported that patients with poor insight are less likely than are those with good or fair insight to respond to first-line treatments such as exposure and response prevention (ERP). Despite the clinical relevance of poor insight, very little research has focused on how to enhance therapy with strategies specifically used to target it. In this report, we use a case study to demonstrate how different techniques can be emphasized or integrated with standard ERP to improve treatment outcomes for this subset of patients.

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