Treating OCD: the Effectiveness of
Exposure and Response Prevention
Obsessive-compulsive
disorder, commonly referred to as OCD, is an anxiety disorder diagnostically
characterized by undesirable and invasive neurotic episodic thoughts or agonizing
images. Generally, such occurrences
foster irrational behavior in an attempt to pacify or prevent the thoughts or
circumstances associated therein (Butcher, Mineka, & Hooley, 2010). In effort to further explicate this condition,
a synopsis of an OCD treatment is provided hereafter regarding the purpose of
the research, hypothesis, procedure, results and indications, strengths and
weaknesses, and psychological value.
Within the article, Patient adherence predicts outcome from cognitive behavioral therapy in
obsessive-compulsive disorder (2011), empirical research is presented concerning
the treatment of OCD to evaluate the effectiveness of cognitive behavioral
techniques. In particular, the focus was
exposure and response prevention (EX/RP).
Formerly, researchers proposed that more personalized care between sessions
enhanced favorable results among OCD sufferers.
More specifically, patient adherence to facing fears and triggers
(exposure) in conjunction to abstaining from avoiding such occurrences
(response prevention) was considered to promote positive outcomes. However, the effectiveness of EX/RP methods
remained controversial (Simpson, Maher, Wang, Bao, Foa, & Franklin, 2011). Arguably, “Woods, Chambless, and Steketee (2002) found
no significant relationship between EX/RP outcome and patient homework
adherence” (Simpson et al., 2011, p.
248). Subsequently, it should be noted
that the aforementioned studies utilized contrasting tools to assess
patient adherence. Issues concerning
validity and reliability were prevalent as well. Hence, researchers collaborated at the Anxiety
Disorders Clinic at the New York State Psychiatric Institute, Columbia University,
in an attempt to adequately determine the correlation of patient
adherence to the effectiveness of treatment outcome in OCD patients. More distinctively, they speculated
that “patient adherence to between-session EX/RP assignments would be inversely associated with post-treatment
OCD severity” (Simpson et al., 2011,
p. 248). In other words, as patients
fulfill the suggested exercises, they lessen the probability of detrimental
outcomes.
In order to test the hypothesis, 30 adults, between 18 and 70
years old, with OCD were considered and declared eligible based on a Yale-Brown
Obsessive-Compulsive Scale (Y-BOCS).
Through a random selection process, they were separated into 2 groups,
those to receive standard EX/RP and those to receive EX/RP in conjunction with
motivational interviewing (MI) techniques (EX/RP + MI), each composed of 15
participants. Each group adhered to
traditional EX/RP regulations inclusive of 3 introductory sessions, weekly
exposure sessions, and daily homework exercises. However, as the variance between groups was
deemed insignificant, participants of both groups were coalesced accordingly
(Simpson et al., 2011). Next, objective independent researchers
evaluated participants prior to therapeutic sessions, then after completion of sessions
3, 11, and 18 in effort to calculate OCD severity, clinical response, and
symptoms of depression. Additionally,
patient adherence was measured prior to exposure sessions 5-18 rating the
amount of exposure, the quality of exposure, and the level of prevention
(Simpson et al., 2011).
Testing results indicated that 5 participants aborted the program
between sessions 4 to 15. Of the
remaining 25 participants, 63.3% achieved a 25% reduction in OCD symptoms and
the remaining 36.7% achieved and excellent resolve. Hence, “patient adherence to
between-session EX/RP assignments significantly predicted posttreatment OCD
severity” (Simpson et al., 2011, p. 249). The implementation of patient homework
adherence had a direct positive affect to decrease OCD symptoms. Therefore, practitioners should observe and
evaluate patients’ conditions and practices in-between sessions.
In a constructive aspect, this research demonstrated
the benefit of cognitive based techniques utilized to treat OCD. Patients’ ability to adhere to EX/RP
exercises directly correlated to their success in overcoming OCD symptoms. However, although varied ages were
represented, this is a sample of only thirty participants from the northeastern
United States. A more comprehensive assessment should be
considered inclusive of a larger quantity of participants from varying regions
and experiences in effort to establish broad conclusions.
These findings are of benefit to the field of
psychology due to the fact that they offer insight to practitioners and hope to
those afflicted with OCD. Personally, it
appears that a participant’s involvement in the therapeutic process increases
the level of success in overcoming such transgressions. In short, with these considerations, treating
patients with OCD becomes more practical and attainable.
As an apprentice in the field, this research offers
guidance in the quest to assess and treat OCD.
The realization of an effective approach fosters a sense of assurance,
encouraging one’s ability to offer support and assistance. Often, implementing relative, tested
information serves as an essential outline to coping with problematic issues
and disorders.
In conclusion, attaining effective resolutions to
abnormal psychological disorders is advantageous. In particular, cognitive behavioral
techniques are quite applicable to the treatment of such afflictions. In respect to OCD, exposure and response
prevention (EX/RP), cognitive-based practices, are beneficial means of
lessening OCD severity. Patients
implementing these exercises enhance the ability to achieve favorable
outcomes. Thus, independent, personal
involvement and recognition in concurrence to therapeutic sessions improve
levels of normalcy and cognitive, inter-relational functioning in OCD cases (Simpson
et al., 2011).
References:
Butcher, J.N., Mineka, S., &
Hooley, J.M. (2010). Abnormal psychology (14th ed.).
Boston: Allyn & Bacon.
Simpson, H.B., Maher, M.J., Wang,
Y., Bao, Y., Foa, E.B., & Franklin,
M. (2011).
Patient
adherence predicts outcome from cognitive behavioral therapy in
obsessive-compulsive
disorder. Journal of Consulting and
Clinical Psychology,
79(2), 247-252.
