Treating OCD

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.