Cognitive-behavioral therapy (CBT) for obsessivecompulsive disorder (OCD) has been shown to be a highly effective treatment for children and adults. In the current review, we briefly describe the historical developments of the treatment, and recent findings related to five areas of inquiry: 1) Does intensity of CBT impact outcome? 2) Does CBT work better on some subtypes of OCD than others? 3) How do cognitive and behavioral strategies relate to outcome? 4) How well does CBT work for children and adolescents with OCD? and 5) Does the combination of CBT and medication work better than CBT alone? After a discussion of these questions, we mention some areas currently being examined.
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References and Recommended Reading
Meyer V: Modification of expectations in cases with obsessional rituals. Behav Res Ther 1966, 4:273–280.
Marks IM, Hodgson R, Rachman S: Treatment of chronic obsessive-compulsive neurosis by in-vivo exposure: A two-year follow-up and issues in treatment. Br J Psychiatry 1975, 127:349–364.
Kozak MJ, Foa EB: Mastery of Obsessive-Compulsive Disorder: A Cognitive-Behavioral Approach (Therapist Guide). San Antonio, TX: Psychological Corporation/Oxford University Press: 1997.
Rabavilas AD, Boulougouris JC, Perissaki C: Therapist qualities related to outcome with exposure in vivo in neurotic patients. J Behav Ther Exp Psychiatry 1979, 10:293–294.
Foa EB, Steketee G, Turner RM, Fischer SC: Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers. Behav Res Ther 1980, 18:449–455.
Grayson JB, Foa EB, Steketee GS: Exposure in vivo of obsessive-compulsives under distracting and attentionfocusing conditions: Replication and extension. Behav Res Ther 1986, 24:475–479.
Foa EB, Steketee G, Milby JB: Differential effects of exposure and response prevention in obsessive-compulsive washers. J Consult Clin Psychol 1980, 48:71–79.
Marks IM, Lelliott PT, Basoglu M, Noshirvani H: Clomipramine, self-exposure and therapist-aided exposure for obsessivecompulsive rituals. Br J Psychiatry 1988, 152:522–534.
Marks IM: Clomipramine and exposure for obsessivecompulsive rituals: I: Br J Psychiatry 1980, 136:1–25.
Cottraux J, Mollard E, Bouvard M, Marks I: A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol 1990, 5:17–30.
van Balkom AJLM, de Haan E, van Oppen P, et al.: Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. J Nerv Ment Dis 1998, 186:492–499.
Fals-Stewart W, Marks AP, Schafer J: A comparison of behavioral group therapy and individual behavior therapy in treating obsessive-compulsive disorder. J Nerv Ment Dis 1993, 181:189–193.
McLean PL, Whittal ML, Thordarson DS, et al.: Cognitive versus behavior therapy in the group treatment of obsessivecompulsive disorder. J Consult Clin Psychol 2001, 69:205–214.
Salkovskis PM: Obsessional-compulsive problems: A cognitive-behavioural analysis. Behav Res Ther 1985, 23:571–583.
Franklin ME, Abramowitz JS, Kozak MJ, et al.: Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. J Consult Clin Psychol 2000, 68:594–602.
Rothbaum BO, Shahar F: Behavioral treatment of obsessivecompulsive disorder in a naturalistic setting. Cogn Behav Pract 2000, 7:262–270.
Warren R, Thomas JC: Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: An effectiveness study. J Anxiety Disord 2001, 15:277–285.
Friedman S, Smith LC, Halpern B, et al.: Obsessive-compulsive disorder in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome with exposure and ritual prevention. Behav Ther 2003, 34:397–410.
Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ: Behavioral versus pharmacological treatments of obsessive compulsive disorder: A meta-analysis. Outcomes Manage 1998, 136:205–216.
Abramowitz JS: Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behav Ther 1996, 27:583–600.
Abramowitz JS, Foa EB, Franklin ME: Exposure and ritual prevention for obsessive-compulsive disorder: Effects of intensive versus twice-weekly sessions. J Consult Clin Psychol 2003, 71:394–398.
Whittal, ML, Thordarson DS, McLean PD: Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behav Res Ther, In press.
Lang AJ, Craske MG, Bjork RA: Implications of a new theory of disuse for the treatment of emotional disorders. Clin Psychol Sci Pract 1999, 6:80–94.
Mataix-Cols D, do Rosario-Campos MC, Leckman JF: A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry 2005, 162:228–238.
McKay D, Abramowitz JS, Calamari JE, et al.: A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clin Psychol Rev 2004, 24:283–313.
Mataix-Cols D, Marks IM, Greist JH, et al.: Obsessivecompulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychother Psychosom 2002, 71:255–262.
Abramowitz JS, Franklin ME, Schwartz SA, Furr JM: Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. J Consult Clin Psychol 2003, 71:1049–1057.
Steketee G, Frost R: Compulsive hoarding: Current status of the research. Clin Psychol Rev 2003, 23:905–927.
Wu KD, Watson D: Hoarding and its relation to obsessive-compulsive disorder. Behav Res Ther, In press.
Grisham JR, Brown TA, Liverant GL, Campbell-Sills L: The distinctiveness of compulsive hoarding from obsessive-compulsive disorder. J Anxiety Disord, In press.
Cottraux J, Note I, Yao SN, et al.: A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychother Psychosom 2001, 70:288–297.
Abramowitz JS, Franklin ME, Foa EB: Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian J Cogn Behav Psychother 2002, 2:89–104.
Wampold BE: The Great Psychotherapy Debate. Hillsdale, NJ: Lawrence Erlbaum: 2001.
Vogel PA, Stiles TC, Götestam KG: Adding cognitive therapy elements to exposure therapy for obsessive compulsive disorder: A controlled study. Behav Cogn Psychother 2004, 32:275–290.
Salkovskis PM: The future of psychological treatments for anxiety. Paper Presented at the European Association for Behavioural & Cognitive Therapies Annual Meeting. Manchester, UK; September 2004.
Abramowitz JS, Whiteside SP, Deacon BJ: The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behav Ther 2005, 36:55–64.
Barrett P, Healy-Farrell L, March J: Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry 2004, 43:46–62.
de Haan E, Hoogduin KA, Buitelaar J, Keijsers G: Behavior therapy versus clomipramine for the treatment of obsessivecompulsive disorder. J Am Acad Child Adolesc Psychiatry 1998, 37:1022–1029.
Pediatric OCD Treatment Study Team: Cognitive-behavioral therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA 2004, 292:1969–1976. This article describes acute outcome for a randomized clinical trial of CBT in children and adolescents, sertraline, and their combination versus placebo. Results indicated that at one site, combined treatment was superior to CBT alone which was equivalent to sertraline and better than placebo, whereas the other site indicated that CBT was equivalent to the combined treatment and superior to sertraline which was somewhat better than placebo.
Piacentini J: Controlled comparison of CBT and relaxation training for childhood OCD. Paper presented at American Psychological Association Annual Meeting. Honolulu, HI; July, 2004.
Silverman W, Kurtines W, Ginsburg G, et al.: Contingency management, self-control, and education support in the treatment of childhood phobic disorders: A randomized clinical trial. J Consult Clin Psychology 1999, 67:675–687.
Valderhaug R, Gotestam KG, Larsson B, Piacentini JC: An open clinical trial of cognitive behaviour therapy for childhood obsessive-compulsive disorder in regular outpatient clinics. Paper presented at the SOGN Centre Conference on Pediatric Anxiety Disorders in Children and Adolescents. Oslo, Norway; May, 2004.
Foa EB, Liebowitz MR, Kozak MJ, et al.: Randomized, placebocontrolled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry 2005, 162:151–161. This article describes a collaborative randomized clinical trial in adults comparing CBT to clomipramine and suggests that CBT alone and in combination were equivalent and more effective than clomipramine alone in an adult, nondepressed sample.
Simpson HB, Liebowitz MR, Foa EB, et al.: Post-treatment effects of exposure therapy and clomipramine in obsessivecompulsive disorder. Depress Anxiety 2004, 19:225–233.
Hohagen F, Winkelmann G, Rasche-Räuchle H, et al.: Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo: Results of a multicentre study. Br J Psychiatry 1998, 173:71–78.
Franklin ME, Simpson HB: Combined treatment of obsessive compulsive disorder: Research findings and clinical applications. J Cogn Psychother, In press.
Cottraux J, Mollard E, Bouvard M, Marks I: Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: One-year followup. Psychiatry Res 1993, 49:63–75.
Kordon A, Kahl KG, Broocks A, et al.: Clinical outcome in patients with obsessive-compulsive disorder after discontinuation of SRI treatment: Results from a two-year follow-up. Eur Arch Psychiatry Clin Neurosci 2005, 255:48–50.
Foa EB, Kozak MJ, Steketee GS, McCarthy PR: Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behaviour therapy. Br J Clin Psychol 1992, 31:279–292.
Tolin DF, Maltby N, Diefenbach GJ, Hannan SE, Worhunsky P: Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial. J Clin Psychiatry 2004, 65:922–931.
Franklin ME, Abramowitz JS, Bux DA, et al.: Cognitivebehavioral therapy with and without medication in the treatment of obsessive-compulsive disorder. Professional Psychol Res Pract 2002, 33:162–168.
Rachman SJ: Naughty thoughts. Paper Presented at the European Association for Behavioural & Cognitive Therapies Annual Meeting. Manchester, UK; September 2004.
Rachman SJ: The Treatment of Obsessions. New York: Oxford University Press, 2003.
Freeston MH, Ladouceur R, Gagnon F, Thibodeau N: Cognitive--behavioral treatment of obsessive thoughts: A controlled study. J Consult Clin Psychol 1997, 65:405–413.
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Huppert, J.D., Franklin, M.E. Cognitive behavioral therapy for obsessive-compulsive disorder: An update. Curr Psychiatry Rep 7, 268–273 (2005). https://doi.org/10.1007/s11920-005-0080-x