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Obsessive Compulsive Disorder

  • Martin E. Franklin
  • Sophia Talbott
Reference work entry

Abstract:

The development of basic competence and the progression from basic to expert competence in delivering cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) is a complex endeavor that has rarely been the focus of discussion in the literature despite the obvious importance of the topic. In this chapter we endeavored to develop a basic set of therapist skills that range from: 1) comprehensive and yet focused assessment of core symptoms; 2) differential diagnosis from disorders that overlap OCD; 3) clinical management of the common comoridities likely to be encountered; 4) providing a clear rationale for the treatment procedures that flow logically from a neurobehavioral framework; 5) conveying the current state of the treatment literature and its implications for treatment choice; and 6) developing reliance on the conceptual model of OCD to inform treatment progression. The movement from basic competence to expert delivery of CBT for OCD requires continuing education and monitoring of the extant literature, treating a sufficiently high volume of cases to master the heterogeneity of OCD presentation, and therapists’ willingness to acknowledge what they do not yet know and persistence in seeking out professional opportunities to bridge the gaps in their knowledge.

Keywords

Cognitive Behavioral Therapy Obsessive Compulsive Disorder Obsessive Compulsive Disorder Patient Obsessive Compulsive Disorder Symptom Comorbid Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abramowitz, J. S., & Foa, E. B. (2000). Does major depressive disorder influence outcome of exposure and response prevention for OCD? Behavior Therapy, 31, 795–800.CrossRefGoogle Scholar
  2. Abramowitz, J. S., Foa, E. B., & Franklin, M. E. (2003). Exposure and ritual prevention for obsessive-compulsive disorder: Effects of intensive versus twice-weekly sessions. Journal of Consulting & Clinical Psychology, 71, 394–398.CrossRefGoogle Scholar
  3. Abramowitz, J. S., Whiteside, S. P., & Deacon, R. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36, 55–63.CrossRefGoogle Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author 457.Google Scholar
  5. Barrett, P. M., Farrell, L., Pina, A. A., Peris, T. S., & Piacentini, J. (2008). Evidence-based psychosocial treatments for child and adolescent obsessive- compulsive disorder. Journal of Clinical Child and Adolescent Psychology. Special Issue: Evidence-based psychosocial treatments for children and adolecents: A ten year update, 1, 131–155.Google Scholar
  6. Barsky, A. J., & Ahern, D. K. (2004). Cognitive behavior therapy for hypochondriasis: A randomized controlled trial. Journal of the American Medical Association, 291, 1464–1470.PubMedCrossRefGoogle Scholar
  7. Baxter, L. J., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Guze, B. H., Mazziotta, J. C. et al. (1992). Caudate glucose metabolic rate change with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry, 49, 681–689.PubMedCrossRefGoogle Scholar
  8. Bliss, J. (1980). Sensory experiences of Gilles de la Tourette syndrome. Archives of General Psychiatry, 37, 1343–1347.PubMedCrossRefGoogle Scholar
  9. Cottraux, J., Mollard, E., & Bouvard, M. (1990). A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. International Clinics of Psychopharmaco, 5, 17–30.CrossRefGoogle Scholar
  10. Cottraux, J., Note, I., Yao, S. N., Lafont, S., Note, B., Mollard, E. et al. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive-compulsive disorder. Psycho-therapy & Psychosomatics, 70(6), 288–297.CrossRefGoogle Scholar
  11. de Araujo, L. A., Ito, L. M., Marks, I. M., & Deale, A. (1995). Does imagined exposure to the consequences of not ritualising enhance live exposure for OCD? A controlled study. 1. Main outcome. British Journal of Psychiatry, 167, 65–70.PubMedCrossRefGoogle Scholar
  12. Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., Atala, K. D.,& Rasmussen, S. A. (1998). The Brown assessment of beliefs scale: Reliability and validity. American Journal of Psychiatry, 155, 102–108.PubMedGoogle Scholar
  13. Emmelkamp, P. M. G., & Beens, H. (1991). Cognitive therapy with obsessive-compulsive disorder: A comparative evaluation. Behaviour Research & Therapy, 29, 293–300.CrossRefGoogle Scholar
  14. Emmelkamp, P. M. G., Visser, S., & Hoekstra, R. J. (1988). Cognitive therapy vs. exposure in vivo in the treatment of obsessive-compulsives. Cognitive Therapy & Research, 12, 103–114.CrossRefGoogle Scholar
  15. Fals-Stewart, W., Marks, A. P., & Schafer, J. (1993).A comparison of behavioral group therapy and individual behavior therapy in treating obsessive-compulsive disorder. Journal of Nervous and Mental Disease, 181, 189–193.PubMedCrossRefGoogle Scholar
  16. Foa, E. B., Franklin, M. E., & Moser, J. (2002). Context in the clinic: How well do CBT and medications work in combination. Biological Psychiatry, 52, 989–997.CrossRefGoogle Scholar
  17. Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In Rothbaum, B. O. (Ed.), Pathological anxiety: Emotional processing in etiology and treatment (pp. 245–265). New York: Guilford.Google Scholar
  18. Foa, E. B., & Kozak, M. J. (1985). Treatment of anxiety disorders: Implications for psychopathology. In Tuma, A. H., & Maser, J. D. (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ: Erlbaum.Google Scholar
  19. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psycho-logical Bulletin, 99, 20–35.CrossRefGoogle Scholar
  20. Foa, E. B., & Kozak, M. J. (1996). Psychological treatments for obsessive compulsive disorder. In Mavissakalian, M. R., & Prien, R. P. (Eds.), Long-term treatments of anxiety disorders (pp. 285–309). Washington, DC: American Psychiatric Press.449–455.Google Scholar
  21. Foa, E. B., Kozak, M. J., Goodman, W. K., Hollander, E., Jenike, M. A., & Rasmussen, S. (1995). DSM-IV filed trial: Obsessive compulsive disorder. American Journal of Psychiatry, 152, 90–96.PubMedGoogle Scholar
  22. Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S. O., Campeas, R., Franklin, M. E. et al. (2005). Treatment of obsessive compulsive disorder by exposure and ritual prevention, clomipramine, and their combination: A randomized, placebo-controlled trial. American Journal of Psychiatry, 162, 151–161.PubMedCrossRefGoogle Scholar
  23. Foa, E. B., Steketee, G., Grayson, B., Turner, M., & Latimer, P. (1984). Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects. Behavior Therapy, 15, 450–472.CrossRefGoogle Scholar
  24. Foa, E. B., Steketee, G., Turner, R. M., & Fischer, S. C. (1980). Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers. Behaviour Research and Therapy, 18, 449–455.Google Scholar
  25. Franklin, M. E., Abramowitz, J. S., Kozak, M. J., Levitt, J., & Foa, E. B. (2000). Effectiveness of exposure and ritual prevention for obsessive compulsive disorder: Randomized compared with non-randomized samples. Journal of Consulting and Clinical Psychology, 68, 594–602.PubMedCrossRefGoogle Scholar
  26. Franklin, M. E., Abramowitz, J. S., Bux, D. A., Zoellner, L. A., & Feeny, N. C. (2002). Cognitive-behavioral therapy with and without medication in the treatment of obsessive-compulsive disorder. Professional Psycho-logy: Research and Practice, 33, 162–168.CrossRefGoogle Scholar
  27. Franklin, M. E., Foa, E. B., & March, J. S. (2003). The Pediatric OCD Treatment Study (POTS): Rationale, design and methods. Journal of Child and Adolescent Psychopharmacology, 13(suppl. 1), 39–52.CrossRefGoogle Scholar
  28. Franklin, M. E., Kozak, M. J., Cashman, L. A., Coles, M. E., Rheingold, A. A., & Foa, E. B. (1998). Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: An open clinical trial. Journal of American Academic Child & Adolescent Psychiatry, 37, 412–419.CrossRefGoogle Scholar
  29. Franklin, M. E., & Simpson, H. B. (2005). Combining pharmacotherapy and exposure plus ritual prevention for obsessive compulsive disorder: Research findings and clinical applications. Journal of Cognitive Psychotherapy, 19, 317–330.CrossRefGoogle Scholar
  30. Franklin, M. E., & Tolin, D. F. (2007). Treating trichotillomania: Cognitive-behavioral therapy for hairpulling and related problems. New York: Springer.Google Scholar
  31. Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rheaume, J., Letarte, H. et al. (1997). Cognitive-behavioral treatment of obsessive thoughts: A controlled study. Journal of Consulting and Clinical Psychology, 65(3), 405–413.PubMedCrossRefGoogle Scholar
  32. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R. et al. (1989b). The Yale-Brown obsessive-compulsive scale. II. Validity. Archives of General Psychiatry, 46, 1012–1016.Google Scholar
  33. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L. et al. (1989a). The Yale-Brown obsessive-compulsive scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.PubMedCrossRefGoogle Scholar
  34. Greist, J. H. (1992). An integrated approach to treatment of obsessive compulsive disorder. Journal of Clinical Psychiatry, 53, 38–41.PubMedGoogle Scholar
  35. Himle, M. B., & Franklin, M. E. (in press). The more you do it, the easier it gets: Exposure and response prevention for OCD. Cognitive & Behavioral Practice.Google Scholar
  36. Hodgson, R. J., Rachman, S., & Marks, L. M. (1972). The treatment of chronic obsessive-compulsive neurosis: Follow-up and further findings. Behaviour Research and Therapy, 10, 181–189.PubMedCrossRefGoogle Scholar
  37. Hohagen, F., Winkelmann, G., Rasche-Räuchle, H., Hand, I., Münchau, N., Hiss, H. et al. (1998). Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study. British Journal of Psychiatry, 173, 71–78.Google Scholar
  38. Hoogduin, C. A. L., Verdellen, C. W. J., & Cath, D. C. (1997). Exposure and response prevention in the treatment of Gilles de la Tourette’s syndrome: Four case studies. Clinical Psychology and Psychotherapy, 4, 125–137.CrossRefGoogle Scholar
  39. Hudson, J. I., Pope, H. G., Jr., & Yurgelun-Todd, D. (1987). A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients. American Journal of Psychiatry, 144, 1283–1287.PubMedGoogle Scholar
  40. Jaycox, L. H., Foa, E. B., & Morral, A. R. (1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185–192.PubMedCrossRefGoogle Scholar
  41. Karno, M., Golding, J. M., Sorenson, S. B., & Burnam, M. A. (1988). The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry, 45, 1094–1099.PubMedCrossRefGoogle Scholar
  42. Kasvikis, Y. G., Tsakiris, F., Marks, I. M., Basaglu, M., & Nashirvani, H. F. (1986). Past history of Anorexia Nervosa in women with obsessive-compulsive disorder. The International Journal of Eating Disorders, 5, 1069–1075.CrossRefGoogle Scholar
  43. Kozak, M. J., & Foa, E. B. (1994). Obsessions, overvalued ideas, and delusions in obsessive compulsive disorder. Behaviour Research and Therapy, 32, 343–353.PubMedCrossRefGoogle Scholar
  44. Kozak, M. J., Foa, E. B., & Steketee, G. (1988). Process and outcome of exposure treatment with obsessive-compulsives: Psychophysiological indicators of emotional processing. Behavior Therapy, 19, 157–169.CrossRefGoogle Scholar
  45. Laessle, R., Kittl, S., Fichter, M., Wittchen, H., & Pirke, K. (1987). Major affective disorder in anorexia nervosa and bulimia. British Journal of Psychiatry, 151, 785–789.PubMedCrossRefGoogle Scholar
  46. Leckman, J. F., & Chittenden, E. H. (1990). Gilles de La Tourette’s syndrome and some forms of obsessive-compulsive disorder may share a common genetic diathesis. Encephale, 16, 321–323.PubMedGoogle Scholar
  47. Leckman, J. F., Walker, D. E., & Cohen, D. J. (1993). Premonitory urges in Tourette’s syndrome. American Journal of Psychiatry, 150, 98–102.PubMedGoogle Scholar
  48. Lindsay, M., Crino, R., & Andrews, G. (1997). Controlled trial of exposure and response prevention in obsessive compulsive disorder. British Journal of Psychiatry, 171, 135–139.PubMedCrossRefGoogle Scholar
  49. Marks, I. M., Lelliott, P., Basoglu, M., Noshirvami, H., Monteiro, W., Cohen, D. et al. (1988). Clomipramine self-exposure, and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522–534.PubMedCrossRefGoogle Scholar
  50. Marks, I. M., Stern, R. S., Mawson, D., Cobb, J., & McDonald, R. (1980). Clomipramine and exposure for obsessive-compulsive rituals-I. British Journal of Psychiatry, 136, 1–25.PubMedCrossRefGoogle Scholar
  51. Mathews, A. M., Johnston, D. W., Shaw, P. M., & Gelder, M. G. (1974). Process variables and the prediction of outcome in behavior therapy. British Journal of Psychiatry, 125, 256–264.CrossRefGoogle Scholar
  52. McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S., Sochting, I., Koch, W. J. et al. (2001). Cognitiveversus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 69(2), 205–214.PubMedCrossRefGoogle Scholar
  53. Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4, 273–280.PubMedGoogle Scholar
  54. Mink, J. W. (2001). Neurobiology of basal ganglia circuits in Tourette syndrome: faulty inhibition of unwanted motor patterns? Advances in Neurology, 85, 113–22.PubMedGoogle Scholar
  55. Mowrer, O. A. (1939). A stimulus-response analysis of anxiety and its role as a reinforcing agent. Psychological Review, 46, 553–565.CrossRefGoogle Scholar
  56. Mowrer, O. A. (1960). Learning theory and behavior. New York: Wiley.CrossRefGoogle Scholar
  57. Pauls, D. L., Towbin, K. E., Leckman, J. F., Zahner, G. E., & Cohen, D. J. (1986). Gilles de la Tourette’s Syn-drome and obsessive-compulsive disorder. Evidence Supporting a genetic relationship. Archives of General Psychiatry, 43, 1180–1182.PubMedCrossRefGoogle Scholar
  58. Pediatric OCD Treatment Study Team. (2004). Cognitive-behavioral therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association, 292, 1969–1976.CrossRefGoogle Scholar
  59. Piacentini, J., Bergman, R. L., Jacobs, C., McCracken, J. T., & Kretchman, J. (2002). Open trial of cognitive behaviour therapy for childhood obsessive-compulsive disorder. Journal of Anxiety Disorders, 16, 207–219.PubMedCrossRefGoogle Scholar
  60. Piacentini, J., Peris, T. S., Bergman, R. L., & Chang, S. (2007). Functional impairment in childhood OCD: Development and psychometrics properties of the Child Obsessive-Compulsive Impact Scale–Revised (COIS-R). Journal of Clinical Child and Adolescent Psychology, 36, 645–653.PubMedCrossRefGoogle Scholar
  61. Rabavilas, A. D., Boulougouris, J. C., & Stefanis, C. (1976). Duration of flooding sessions in the treatment of obsessive-compulsive patients. Behaviour Research and Therapy, 14, 349–355.PubMedCrossRefGoogle Scholar
  62. Rasmussen, S. A., & Eisen, J. L. (1989). Clinical features and phenomenology of obsessive-compulsive disorder. Psychiatric Annals, 19, 67–73.Google Scholar
  63. Rasmussen, S. A., & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM III obsessive-compulsive disorder. American Journal of Psychiatry, 1943, 317–382.Google Scholar
  64. Rothbaum, B. O., & Shahar, F. (2000). Behavioral treatment of obsessive-compulsive disorder in a naturalistic setting. Cognitive and Behavioral Practice, 7, 262–270.CrossRefGoogle Scholar
  65. Rowe, M. K., & Craske, M. G. (1998). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research & Therapy, 36, 719–34.CrossRefGoogle Scholar
  66. Salkovskis, P. M. (1985). Obsessional compulsive problems: A cognitive-behavioral analysis. Behaviour Research and Therapy, 23, 571–583.PubMedCrossRefGoogle Scholar
  67. Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K. et al. (1997). Children’s Yale-Brown obsessive compulsive scale: Reliability and validity. Journal of American Academy of Child Adolescent Psychiatry, 36, 844–852.CrossRefGoogle Scholar
  68. Simpson, H. B., Liebowitz, M. R., Foa, E. B., Kozak, M. J., Schmidt, A. B., Rowan, V. et al. (2004). Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder. Depression & Anxiety, 19, 225–233.CrossRefGoogle Scholar
  69. Simpson, H. B., Zuckoff, A., Page, J. R., Franklin, M. E., & Foa, E. B. (2008). Adding motivational interviewing to exposure and ritual prevention for obsessive–compulsive disorder: An open pilot trial. Cognitive Behaviour Therapy, 37, 38–49.PubMedCrossRefGoogle Scholar
  70. Steketee, G. S., Foa, E. B., & Grayson, J. B. (1982). Recent advances in the behavioral treatment of obsessive-compulsives. Archives of General Psychiatry, 39(12), 1365–1371.PubMedCrossRefGoogle Scholar
  71. Steketee, G., Grayson, J. B. & Foa, E. B. (1987). A comparison of characteristics of obsessive-compulsive disorder and other anxiety disorders. Journal of Anxiety Disorders, 1, 325–335.Google Scholar
  72. Storch, E. A., Geffken, G. R., Merlo, L. J., Mann, G., Duke, D., Munson, M. et al. (2007). Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Comparison of intensive and weekly approaches. Journal of American Academy of Child & Adolescent Psychiatry, 46(4), 464–478.Google Scholar
  73. Storch, E., Larson, M. J., Merlo, L., Keeley, M. L., Marni, J., Geffken, G. R. et al. (2008). Comorbidity of pediatric obsessive-compulsive disorder and anxiety disorders: Impact on symptom severity and impairment. Jour-nal of Psychopathology and Behavioral Assessment, 30, 111–120.CrossRefGoogle Scholar
  74. Swedo, S. E., Leonard, H. L., Garvey, M., Mittleman, B., Allen, A. J., Perlmutter, S. et al. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. American Journal of Psychiatry, 155, 264–271.PubMedGoogle Scholar
  75. Tynes, L. L., White, K., & Steketee, G. S. (1990). Towarda new nosology of obsessive-compulsive disorder. Comprehensive Psychiatry, 31, 465–80.PubMedCrossRefGoogle Scholar
  76. Valderhaug, R., Larsson, B., Gotestam, K. G., & Piacentini, J. (2007). An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics. Behaviour Research and Therapy, 45(3), 577-589.Google Scholar
  77. Van Minnen, A., & Hagenaars, M. (2002). Fear activation and habituation patterns as early process predictors of response to prolonged exposure treatment in PTSD. Journal of Traumatic Stress, 15, 359–367.PubMedCrossRefGoogle Scholar
  78. Verdellen, C., Hoogduin, C., Kato, B., Keijsers, G., Cath, D., & Hoijtink, H. (2008). Habituation of premonitory sensations during exposure and response prevention treatment in Tourette’s syndrome. Behavior Modification, 2, 215–227.CrossRefGoogle Scholar
  79. Verdellen, C. W. J., Keijsers, G. P. J., Cath, D. C., & Hoogduin, C. A. L. (2004). Exposure with response prevention versus habit reversal in Tourette’s syndrome: A controlled study. Behaviour Research and Therapy, 42, 501–511.PubMedCrossRefGoogle Scholar
  80. Vogel, P. A., Stiles, T. C., & Götestam, K. G. (2004). Adding cognitive therapy elements to exposure therapy for obsessive-compulsive disorder: A controlled study. Behavioural and Cognitive Psychotherapy, 32, 275–290.CrossRefGoogle Scholar
  81. Warren, R., & Thomas, J. C. (2001). Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: An effectiveness study. Journal of Anxiety Disorders, 15, 277–285.PubMedCrossRefGoogle Scholar
  82. Warwick, H. M., Clark, D. M., Cobb, A., & Salkovskis, P. M. (1996). A controlled trial of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry, 169, 189–195.PubMedCrossRefGoogle Scholar
  83. Whittal, M., Thordarson, D., & McLean, P. (2005). Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy, 43, 1559–1576.PubMedCrossRefGoogle Scholar
  84. Woods, D. W., Piacentini, J., & Himle, M. B. (2005). Premonitory Urge for Tics Scale (PUTS): Initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. Journal of Developmental and Behavioral Pediatrics, 26, 397–403.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • Martin E. Franklin
    • 1
  • Sophia Talbott
    • 1
  1. 1.University of PennsylvaniaPhiladelphiaUSA

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