The Role of the Therapist in Behavior Therapy for OCD

Cognitive-behavioral interventions are considered a first-line treatment of choice for OCD (Franklin % Foa, 1998; March, Frances, Carpenter, % Kahn, 1997). Although cognitive-behavioral therapy has many forms, the strongest evidence base is for exposure and response prevention (ERP). Exposure and response prevention consists of gradual, prolonged exposure to fear-eliciting stimuli or situations, combined with strict abstinence from compulsive behavior. In practice, this means that a patient with contamination concerns would be encouraged to touch progressively more contaminated objects while simultaneously refraining from washing or cleaning. Similarly, a patient with obsessive concerns about harming other people while driving might be encouraged to drive in increasingly congested areas without looking in the rear-view mirror. The purpose of exposure exercises is to allow the patient to experience a reduction of their fear response, recognize that these situations are not excessively dangerous, and learn that their fear will not persist indefinitely. Thus, ERP's mechanisms of action may include modification of maladaptive cognitions as well as the “behavioral” mechanisms of habituation and extinction (Foa % Kozak, 1986).