Self-Directed Exposure in the Treatment of OCD

Since Victor Meyer's (1966) first report on two successfully treated OCD patients, the behavioral intervention of exposure and response prevention (ERP) has become firmly established as a highly effective method for reducing symptoms of the disorder (see Abramowitz, 1997; van Balkom et al., 1994, for reviews). However, as several authors have noted (Foa & Kozak, 1986; Steketee & Barlow, 2002), no one is entirely sure why exposure is effective. It appears that an extended period of confronting a feared situation permits the emotional discomfort associated with that situation to dissipate and subsequently provokes a less intense reaction. As a result of repeated exposure to obsessional material, coupled with the prevention of those rituals that serve the initial function of neutralizing their associated fears, the individual's attitudes and expected negative outcomes are altered. As Steketee and Barlow (2002) conclude, “… the major procedural issue in treatment is arranging for sufficient exposure to occur without interruption from neutralizing strategies” (p. 540).