Abstract
Repugnant obsessions are a common theme of intrusions in obsessive-compulsive disorder and are typically ego-dystonic. Exposure and response prevention (ERP) is the first-line intervention and involves in vivo and/or imaginal exposures. Many therapists are however reluctant to conduct ERP and the reasons remain unclear. Similarly, little is known about therapist preference for in vivo versus imaginal exposure for repugnant obsessions. To address these gaps, 200 therapists read vignettes of an in vivo and imaginal exposure for each repugnant obsession subtype and indicated whether they would have clients complete it. If not, they selected their primary refusal reason. Therapists were more likely to refuse in vivo (versus imaginal) exposures related to intentional/accidental harm, religion, and sexual orientation. There were no differences in willingness for pedophilic obsessions, with both forms receiving more refusals than approvals. “Dangerous/harmful to client/others” and “not necessary for therapeutic success” were most frequently selected as refusal reasons.
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The datasets and materials utilized and/or analyzed during the current study are available from the corresponding author on reasonable request.
Notes
in vivo difficulty: M = 4.33, SD = 0.58; imaginal difficulty: M = 4.33, SD = 0.58.
in vivo difficulty: M = 4.33, SD = 0.58; imaginal difficulty: M = 4.33, SD = 0.58.
in vivo difficulty: M = 4.33, SD = 0.58; imaginal difficulty: M = 4.67, SD = 0.58.
in vivo difficulty: M = 4.33, SD = 0.58; imaginal difficulty: M = 4.67, SD = 0.58.
in vivo difficulty: M = 4.33, SD = 0.58; imaginal difficulty: M = 5.00, SD = 0.00.
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Dubravka Gavric, Irena Milosevic, Randi McCabe, Noam Soreni, Gillian Alcolado, and Karen Rowa contributed to the study conception, design, and material preparation. Data collection and analyses were performed by Jean-Philippe Gagné, Christina Puccinelli, Dubravka Gavric, Shiu F. Wong, and Karen Rowa. The first draft of the manuscript was written by Jean-Philippe Gagné. Dubravka Gavric, Christina Puccinelli, and Karen Rowa commented on previous versions. All authors read and approved the final manuscript.
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Gagné, JP., Puccinelli, C., Gavric, D. et al. In vivo versus imaginal: Comparing therapists’ willingness to engage in both forms of exposure therapy for repugnant obsessions. Curr Psychol 42, 7837–7840 (2023). https://doi.org/10.1007/s12144-021-02161-0
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DOI: https://doi.org/10.1007/s12144-021-02161-0