Cognitive-Behavior Therapy Outcomes for Obsessive-Compulsive Disorder: Exposure and Response Prevention
Abstract
Obsessive-compulsive disorder (OCD) is a chronic, disabling condition that afflicts 2% to 3% of the population. Cognitive-behavioral therapy consisting of exposure and response prevention (EX/RP) is the first-line psychologic treatment for OCD. This article describes in detail the components and structure of EX/RP to provide a practical guide for clinicians. We also review the research supporting the use of EX/RP, both as a monotherapy and in combination with pharmacotherapy. We also discuss potential mechanisms of action for EX/RP and conclude with directions for future research. [ Psychiatr Ann . 2015;45(6):303–307.]
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Researchers have yet to identify how these brain changes are directly related to processes that lead to clinical improvement.
“However, researchers have yet to identify how these changes are directly related to processes that then lead to clinical improvement.[44]”
From Exposure and response prevention for obsessive-compulsive disorder: A review and new directions (2019) · cites this paper as [44]
It is still unclear exactly how ERP works or why some people respond to it whereas others do not.
“it is still unclear exactly how it works or why some people respond to it whereas others do not.[44]”
From Exposure and response prevention for obsessive-compulsive disorder: A review and new directions (2019) · cites this paper as [44]
Cites
Emotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396 · see citing works
The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010) · Molecular Psychiatry · doi:10.1038/mp.2008.94 · Cited by 2,771 · see citing works
Optimizing inhibitory learning during exposure therapy
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.10.003 · Cited by 1,607 · see citing works
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
Self-citationPractice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder
(2008) · APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches · doi:10.1176/appi.books.9780890423363.149114 · Cited by 1,028 · see citing works
Self-citationOlatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.08.020 · Cited by 659 · see citing works
Hoarding disorder: a new diagnosis for DSM-V?
Mataix-Cols, D., Frost, R. O., Pertusa, A., Clark, L. A., Saxena, S., Leckman, J. F., Stein, D. J., Matsunaga, H., & Wilhelm, S. (2010) · Depression and Anxiety · doi:10.1002/da.20693 · Cited by 532 · see citing works
Current controversies in the anxiety disorders
Taylor, S. J. (1996) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(96)80355-x · Cited by 497 · see citing works
Modification of expectations in cases with obsessional rituals
Meyer, V. (1966) · Behaviour Research and Therapy · doi:10.1016/0005-7967(66)90023-4 · Cited by 461 · see citing works
Psychological treatment of obsessive–compulsive disorder: A meta-analysis
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.07.001 · Cited by 444 · see citing works
D-Cycloserine Augmented Exposure Therapy for Obsessive-Compulsive Disorder
Kushner, M. G., Kim, S. W., Donahue, C. B., THURAS, P. D., Adson, D. E., Kotlyar, M., McCabe, J., Peterson, J., & Foa, E. B. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.12.020 · Cited by 384 · see citing works
Augmentation of Behavior Therapy With <scp>d</scp> -Cycloserine for Obsessive-Compulsive Disorder
Wilhelm, S., Buhlmann, U., Tolin, D. F., Meunier, S. A., Pearlson, G. D., Reese, H. E., Cannistraro, P., Jenike, M. A., & Rauch, S. L. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07050776 · Cited by 358 · see citing works
Goal-directed learning and obsessive-compulsive disorder
Gillan, C. M., & Robbins, T. W. (2014) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2013.0475 · Cited by 348 · see citing works
Simpson, H. B., Foa, E. B., Liebowitz, M. R., Ledley, D. R., Huppert, J. D., Cahill, S., Vermes, D., Schmidt, A. B., Hembree, E., Franklin, M., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07091440 · Cited by 316 · see citing works
Self-citationTreatment of Chronic Obsessive-Compulsive Neurosis by in-vivo Exposure
Marks, I. M., HODGSON, R. J., & Rachman, S. (1975) · The British Journal of Psychiatry · doi:10.1192/bjp.127.4.349 · Cited by 315 · see citing works
FALS-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
Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., Bergström, J., Kaldo, V., Lindefors, N., Andersson, G., et al. (2012) · Psychological Medicine · doi:10.1017/s0033291712000244 · Cited by 274 · see citing works
Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder
Keeley, M. L., Storch, E. A., Merlo, L. J., & Geffken, G. R. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.04.003 · Cited by 261 · see citing works
VAN BALKOM, A. J. L. M., DE HAAN, E., VAN OPPEN, P., SPINHOVEN, P., HOOGDUIN, K. A. L., & VAN DYCK, R. (1998) · The Journal of Nervous & Mental Disease · doi:10.1097/00005053-199808000-00007 · Cited by 250 · see citing works
Simpson, H. B., Foa, E. B., Liebowitz, M. R., Huppert, J. D., Cahill, S., Maher, M. J., McLean, C. P., Bender, J., Marcus, S. M., Williams, M. T., et al. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.1932 · Cited by 248 · see citing works
Self-citationControlled trial of exposure and response prevention in obsessive–compulsive disorder
Lindsay, M., Crino, R., & Andrews, G. (1997) · British Journal of Psychiatry · doi:10.1192/bjp.171.2.135 · Cited by 245 · see citing works
Response versus remission in obsessive-compulsive disorder
Simpson, H. B., Huppert, J. D., Petkova, E., Foa, E. B., & Liebowitz, M. R. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0214 · Cited by 241 · see citing works
Self-citationRole of inhibition in exposure therapy
Craske, M. G., Liao, B., Brown, L., & Vervliet, B. (2012) · Journal of Experimental Psychopathology · doi:10.5127/jep.026511 · Cited by 237 · see citing works
Cognitive behavioral therapy of obsessive-compulsive disorder
Foa, E. B. (2010) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2010.12.2/efoa · Cited by 236 · see citing works
The treatment of chronic obsessive-compulsive neurosis
Rachman, S., HODGSON, R. J., & Marks, I. M. (1971) · Behaviour Research and Therapy · doi:10.1016/0005-7967(71)90009-x · Cited by 232 · see citing works
The Practice of Exposure Therapy: Relevance of Cognitive-Behavioral Theory and Extinction Theory
Abramowitz, J. S. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.03.003 · Cited by 218 · see citing works
Simpson, H. B., Maher, M. J., Wang, Y., Bao, Y., Foa, E. B., & Franklin, M. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0022659 · Cited by 217 · see citing works
Self-citationThe effects of psychotherapy on brain function: A systematic and critical review
Barsaglini, A., Sartori, G., Benetti, S., Pettersson‐Yeo, W., & Mechelli, A. (2013) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2013.10.006 · Cited by 212 · see citing works
D-cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder
Storch, E. A., Merlo, L. J., Bengtson, M., Murphy, T. K., Lewis, M. H., Yang, M. C., Jacob, M. L., Larson, M., Hirsh, A., Fernandez, M., et al. (2007) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e32819f8480 · Cited by 200 · see citing works
The passing of the two-stage theory of fear and avoidance: fresh possibilities.
Rachman, S. (1976) · Behaviour Research and Therapy · doi:10.1016/0005-7967(76)90066-8 · Cited by 188 · see citing works
Exposure and Response (Ritual) Prevention for Obsessive Compulsive Disorder: Therapist Guide
Foa, E. B., Yadin, E., & Lichner, T. K. (2012) · doi:10.1093/med:psych/9780195335286.001.0001 · Cited by 185 · see citing works
Romanelli, R., Wu, F. M., Gamba, R., Mojtabai, R., & Segal, J. (2014) · Depression and Anxiety · doi:10.1002/da.22232 · Cited by 124 · see citing works
Augmentation Treatment of Psychotherapy for Anxiety Disorders with D‐Cycloserine
Hofmann, S. G., Pollack, M. H., & Otto, M. W. (2006) · CNS Drug Reviews · doi:10.1111/j.1527-3458.2006.00208.x · Cited by 123 · see citing works
Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0013076 · Cited by 110 · see citing works
Need for speed: Evaluating slopes of OCD recovery in behavior therapy enhanced with d-cycloserine
Chasson, G. S., Buhlmann, U., Tolin, D. F., Rao, S. R., Reese, H. E., Rowley, T., Welsh, K. S., & Wilhelm, S. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.03.007 · Cited by 106 · see citing works
Nakatani, E., Nakagawa, A., Nakao, T., Yoshizato, C., Nabeyama, M., Kudo, A., Isomura, K., Kato, N., Yoshioka, K., & Kawamoto, M. (2005) · Psychotherapy and Psychosomatics · doi:10.1159/000086317 · Cited by 102 · see citing works
Simpson, H. B., Zuckoff, A. M., Maher, M. J., Page, J. R., Franklin, M. E., Foa, E. B., Schmidt, A. B., & Wang, Y. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.026 · Cited by 100 · see citing works
Self-citationInternet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study
Andersson, E., Ljótsson, B., Hedman, E., Kaldo, V., Paxling, B., Andersson, G., Lindefors, N., & Rück, C. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-125 · Cited by 94 · 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
Tenneij, N. H., van Megen, H. J. G. M., Denys, D. A. J. P., & Westenberg, H. G. M. (2005) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v66n0913 · Cited by 71 · see citing works
Maher, M. J., Huppert, J. D., Chen, H., Duan, N., Foa, E. B., Liebowitz, M. R., & Simpson, H. B. (2010) · Psychological Medicine · doi:10.1017/s0033291710000620 · Cited by 64 · see citing works
Self-citationSimpson, H. B., Zuckoff, A., Page, J. R., Franklin, M. E., & Foa, E. B. (2008) · Cognitive Behaviour Therapy · doi:10.1080/16506070701743252 · Cited by 60 · see citing works
Self-citationFoa, E. B., Simpson, H. B., Liebowitz, M. R., Powers, M. B., Rosenfield, D., Cahill, S. P., Campeas, R. B., Franklin, M. E., Hahn, C.-G., Hembree, E. A., et al. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m08017 · Cited by 34 · see citing works
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“[41-43] However, researchers have yet to identify how these changes are directly related to processes that then lead to clinical improvement.[44]”
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- Authors
- Wheaton, M. G., Schwartz, M. R., Pascucci, O., & Simpson, H. B.
- Venue
- Psychiatric Annals
- Publisher
- SLACK, Inc.
- Published
- 2015-06
- Volume
- 45
- Issue
- 6
- Pages
- 303-307
- ISSN
- 0048-5713 (ISSN-L)
- 1938-2456
- OpenAlex
- W2625730096
- Cited by
- 7
- References
- 43
- Citations by year
- 2026: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2016: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Annals (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 behavioral therapy, treatment outcomes, mechanism of action
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