Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting
Abstract
Objectives Exposure and response prevention (ERP) remains the most empirically supported psychological treatment for obsessive compulsive disorder (OCD). Clinical guidelines recommend the addition of cognitive approaches to ERP although the presumed additive benefits have not been directly tested. The aim of this was to compare a treatment that integrated cognitive therapy with ERP (ERP + CT) to traditional, manualized ERP to test the additive benefits. Design A longitudinal, randomized control trial design was used. Methods Participants (N = 127) with OCD were randomly assigned to receive individual outpatient ERP or ERP + CT. Obsessive-compulsive symptom severity measures were completed pre- and post-treatment and at 6-month follow-up. Results While both conditions led to significant symptom and obsessive belief reduction, ERP + CT led to significantly greater symptom and belief reduction as compared to ERP across all main symptom presentations of OCD. Based on a priori definitions of effectiveness, more patients in ERP + CT compared to the ERP group were also deemed treatment responders. Conclusions The results of this study suggest that cognitive therapy can be readily integrated with ERP to improve clinical outcomes beyond ERP alone. Practitioner points Both ERP and ERP + CT were effective, however a course of ERP + CT was significantly more effective at reducing symptoms of OCD than the ERP treatment condition. Significantly more participants who received ERP + CT exper…
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CBT treatments that include CT interventions appear to be more tolerated by patients and to reduce dropout, compared to ERP alone.
“Cognitive therapy (CT) is effective, too, in 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).”
From TREATING GUILT-INDUCING SELF-TALK IN OCD WITH DRAMATIZED SOCRATIC DIALOGUE: A STEP BY STEP INTERVENTION (2024) · cites this paper as Rector et al., 2019
CT is effective in treating OCD, both alone and in combination with ERP.
“Cognitive therapy (CT) is effective, too, in 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).”
From TREATING GUILT-INDUCING SELF-TALK IN OCD WITH DRAMATIZED SOCRATIC DIALOGUE: A STEP BY STEP INTERVENTION (2024) · cites this paper as Rector et al., 2019
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- Authors
- Rector, N. A., Richter, M. A., Katz, D., & Leybman, M.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Rector, Neil A.
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2018-07-08
- Volume
- 58
- Issue
- 1
- Pages
- 1-18
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2833812111
- Cited by
- 39
- References
- 53
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 7 · 2019: 4
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- 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, exposure and response prevention, cognitive therapy, treatment efficacy, obsessive beliefs, symptom severity, community-based treatment, outpatient psychotherapy
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Implosive Therapy, Longitudinal Studies, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome
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