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The psychological treatment of obsessive-compulsive disorder
Open accessAbstract
The psychological treatment of obsessive–compulsive disorder (OCD) with exposure and response prevention (ERP) methods is one of the great success stories within the field of mental health. Within the span of about 20 years, the prognosis for individuals with OCD has changed from poor to very good as a result of the development of ERP. This success not withstanding, the procedures are far from perfect because a substantial minority of patients still either refuse treatment, drop out prematurely, or fail to benefit. I begin this article with a review of the development of ERP from early animal research on avoidance learning conducted during the 1950s. Next, I discuss the mechanisms of ERP. The bulk of the article reviews the treatment-outcome literature on ERP for OCD and includes comparisons with cognitive therapy—the “new kid on the block” with respect to psychological treatments for OCD.
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“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 Abramowitz, 2006
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, treatment success remains around 50% when refusal and dropout are considered.”
From A preliminary investigation of the relationships between attachment insecurity, fear of compassion, and OCD severity (2025) · cites this paper as Abramowitz, 2006
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A strength of many ERP trials was the use of the Yale-Brown Obsessive-Compulsive Scale (YBOCS; Goodman, Price et al, 1989 a; b) as an outcome measure. This clinician-administered tool is viewed as the gold standard for ascertaining OCD symptom severity (Abramowitz, 2006; Summerfeldt, 2001).”
From An update on the efficacy of psychological treatments for obsessive-compulsive disorder in adults (2013) · cites this paper as Abramowitz, 2006
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“according to cognitive models, faulty beliefs give rise to obsessional anxiety. Compulsive acts are then performed to ameliorate intrusive thoughts and anxiety”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Abramowitz, 2006
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“To target these cognitive biases, “cognitive therapy” was developed (Rosa‐Alcázar et al., 2008). Cognitive therapy typically involves teaching patients about the implausibility and maladaptive nature of these cognitions”
From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Abramowitz, 2006
The cited source says what the claim attributes to it.
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“While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond.”
From Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD (2024) · cites this paper as Abramowitz, 2006
The cited source says what the claim attributes to it.
In the citing paper
“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 Abramowitz, 2006
The cited source says what the claim attributes to it.
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“There is a substantial average gap of up to 17 years between symptom onset and receipt of treatment [10, 11], together with high rates of disengagement from efficacious treatments such as psychological therapy [12].”
From Testing the psychometric properties of the illness perceptions questionnaire for OCD (IPQ-O) (2019) · cites this paper as [12]
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“Approximately 20–30% of patients drop out of ERP prematurely,[11]”
From Exposure and response prevention for obsessive-compulsive disorder: A review and new directions (2019) · cites this paper as [11]
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Citations
Cites
An inventory for measuring depression
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Goodman, W. K. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810110054008 · Cited by 2,799
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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
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Metadata
- Authors
- Abramowitz, J. S.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Abramowitz, Jonathan S
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2006-06
- Volume
- 51
- Issue
- 7
- Pages
- 407-416
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- OpenAlex
- W2131506339
- Cited by
- 371
- References
- 44
- Citations by year
- 2026: 18 · 2025: 22 · 2024: 22 · 2023: 17 · 2022: 27 · 2021: 22 · 2020: 26 · 2019: 18 · 2018: 12 · 2017: 12 · 2016: 12 · 2015: 22 · 2014: 29 · 2013: 25 · 2012: 23
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (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, exposure and response prevention, cognitive therapy, avoidance learning, treatment outcomes, treatment discontinuation, treatment resistance
- MeSH terms
- Combined Modality Therapy, Desensitization, Psychologic, Humans, Inhibition, Psychological, Obsessive-Compulsive Disorder, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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