Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials.
Abstract
Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Despite decades of research on exposure therapy, response rates have not been improving.
“Despite decades of research on exposure therapy, response rates have not been improving (Springer, Levy, & Tolin, 2018; Whittal, Robichaud, Thordarson, & McLean, 2008).”
From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Whittal, Robichaud, Thordarson, & McLean, 2008
Cites
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.1.151 · Cited by 1,048 · see citing works
Eddy, K. T., Dutra, L., Bradley, R., & Westen, D. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.08.004 · Cited by 475 · see citing works
Cognitive versus behavior therapy in the group treatment of obsessive–compulsive disorder
McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S., Söchting, I., Koch, W. J., Paterson, R., & Anderson, K. W. (2001) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.69.2.205 · Cited by 332 · see citing works
Self-citationFALS-STEWART, W., MARKS, A. P., & SCHAFER, J. (1993) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199303000-00007 · Cited by 279 · see citing works
Cognitive therapy vs. exposure in vivo in the treatment of obsessive–compulsives
Emmelkamp, P. M. G., Visser, S., & Hoekstra, R. J. (1988) · Cognitive Therapy and Research · doi:10.1007/bf01172784 · Cited by 160 · see citing works
Cognitive-behavioral group therapy in obsessive–compulsive disorder: a randomized clinical trial
Volpato Cordioli, A., Heldt, E., Braga Bochi, D., Margis, R., Basso de Sousa, M., Fonseca Tonello, J., Gus Manfro, G., & Kapczinski, F. (2003) · Psychotherapy and Psychosomatics · doi:10.1159/000070785 · Cited by 158 · see citing works
Potentials and Limitations of Cognitive Treatments for Obsessive‐Compulsive Disorder
Abramowitz, J. S., Taylor, S., & McKay, D. (2005) · Cognitive Behaviour Therapy · doi:10.1080/16506070510041202 · Cited by 142 · see citing works
van Oppen, P., van Balkom, A. J. L. M., de Haan, E., & van Dyck, R. (2005) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v66n1111 · Cited by 97 · see citing works
CBT for OCD: The rationale, protocol, and challenges
Whittal, M. L., & McLean, P. D. (1999) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(99)80057-1 · Cited by 59 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090 · see citing works
Mind the gap: improving the dissemination of CBT
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., Freeston, M., Garety, P. A., Hollon, S. D., Ost, L. G., et al. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.003 · Cited by 569 · see citing works
Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K., & Veale, D. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.058 · Cited by 283 · see citing works
Ougrin, D. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-200 · Cited by 201 · see citing works
Clark, D. A. (2013) · The Wiley Handbook of Cognitive Behavioral Therapy · doi:10.1002/9781118528563.wbcbt02 · Cited by 192 · see citing works
Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder.
Key, B. L., Rowa, K., Bieling, P., McCabe, R., & Pawluk, E. J. (2017) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2076 · Cited by 103 · see citing works
A meta-analysis of relapse rates in cognitive-behavioral therapy for anxiety disorders
Levy, H. C., O’Bryan, E. M., & Tolin, D. F. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102407 · Cited by 91 · see citing works
Steketee, G., Siev, J., Yovel, I., Lit, K., & Wilhelm, S. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.04.004 · Cited by 88 · see citing works
Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. J. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031865 · Cited by 85 · see citing works
An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults
Ponniah, K., Magiati, I., & Hollon, S. D. (2013) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2013.02.005 · Cited by 79 · see citing works
“…therapy based on CAM = therapy based on IBA Tenneij et al., 2005 (NED) DSM-IV; MINI ERP + continued meds > continued meds alone (in meds responders) Whittal et al., 2005, 2008 (CAN) DSM-IV; SCID ERP = CBT Sousa et al., 2006; Borges et al., 2011 (BRA) DSM-IV; MINI Group CBT > meds Anderson & Rees,…”
BackgroundMethodInfluentialWhat Makes a Quality Therapy? A Consideration of Parsimony, Ease, and Efficiency
Cougle, J. R. (2012) · Behavior Therapy · doi:10.1016/j.beth.2010.12.007 · Cited by 60 · see citing works
Manos, R. C., Cahill, S. P., Wetterneck, C. T., Conelea, C. A., Ross, A. R., & Riemann, B. C. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.05.001 · Cited by 55 · see citing works
Andersson, E., Ljótsson, B., Hedman, E., Enander, J., Kaldo, V., Andersson, G., Lindefors, N., & Rück, C. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.10.003 · Cited by 52 · see citing works
Foa, E. B., Simpson, H. B., Rosenfield, D., Liebowitz, M. R., Cahill, S. P., Huppert, J. D., Bender Jr, J., McLean, C. P., Maher, M. J., Campeas, R., et al. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14m09044 · Cited by 34 · see citing works
Smith, B. M., Smith, G. S., & Dymond, S. (2020) · Journal of the Experimental Analysis of Behavior · doi:10.1002/jeab.573 · Cited by 27 · see citing works
Belloch, A., Cabedo, E., Carrió, C., Fernández-Alvarez, H., García, F., & Larsson, C. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.10.015 · Cited by 21 · see citing works
Sunde, T., Walseth, L. T., Himle, J. A., Vogel, P. A., Launes, G., Haaland, V. Ø., Hoffart, A., Johnson, S. U., & Haaland, Å. T. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.06.002 · Cited by 11 · see citing works
Psychological Models and Treatments of OCD for Adults
Berman, N. C., Schwartz, R., & Park, J. (2017) · The Wiley Handbook of Obsessive Compulsive Disorders · doi:10.1002/9781118890233.ch12 · Cited by 8 · see citing works
Wheaton, M. G., Schwartz, M. R., Pascucci, O., & Simpson, H. B. (2015) · Psychiatric Annals · doi:10.3928/00485713-20150602-05 · Cited by 7 · see citing works
Obsessive-Compulsive Spectrum Disorders: Diagnosis, Theory, and Treatment
Clark, D. A., & Simos, G. (2013) · CBT for Anxiety Disorders · doi:10.1002/9781118330043.ch2 · Cited by 3 · see citing works
Saliani, A. M., Perdighe, C., Zaccari, V., Luppino, O. I., Mancini, A., Tenore, K., & Mancini, F. (2024) · PubMed Central · doi:10.36131/cnfioritieditore2023060104 · Cited by 3 · see citing works
“…treating OCD, both alone and in combination with ERP, and CBT treatments that include CT interventions appear to be more tolerated by patients and to reduce dropout, compared to ERP alone (Abramowitz, 2006; Fisher & Wells, 2005; Rector et al., 2019; Rosa-Alcázar et al., 2008; Whittal et al., 2008).”
Background
- Authors
- Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D.
- Affiliations
- University of British Columbia (CA)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2008
- Volume
- 76
- Issue
- 6
- Pages
- 1003-1014
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W1970973644
- Cited by
- 110
- References
- 9
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 5 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 2 · 2015: 8 · 2014: 18 · 2013: 8 · 2012: 8
- FWCI
- 9.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, group therapy, individual psychotherapy, cognitive therapy, exposure and response prevention, long-term treatment outcomes, relapse, treatment discontinuation, treatment tolerability, depression, recovery
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Male, Obsessive-Compulsive Disorder, Psychotherapy, Group, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
