COGNITIVE THERAPY FOR
Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder that affects about 3% of the population (Wilhelm, 2000). As discussed in Chapters 1 and 2, it is characterised by the presence of obsessions, which increase anxiety, and compulsions, which usually decrease anxiety. Obsessions are intrusive repetitive thoughts, impulses or images that are unacceptable or unwanted and give rise to resistance. Typical themes involve sexuality, religion, harming, contamination and disease. Sufferers normally try to neutralise these thoughts with other thoughts or actions and to avoid situations that trigger the obsession. Compulsions are overt or covert acts that often take the form of checking, cleaning, ordering, repeating, hoarding and counting. Usually sufferers report both obsessions and compulsions, although cases of obsessions only are not uncommon.
Exposure and response prevention (ERP) has been the treatment of choice for OCD since the development of behavioural techniques for anxiety (see Chapter 15 for a detailed description of ERP techniques). Prior to this, OCD was considered largely resistant to psychological intervention. The pioneering work of Rachman, Hodgson and Marks in the 1970s put OCD firmly on the treatment map, and numerous studies have proved the efficacy of ERP (Emmelkamp, 1982; Marks, 1987; Rachman & Hodgson, 1980). Nonetheless, ERP has several clinical limitations. A significant number of patients refuse treatment because they are unable to carry out exposure exercises. About 20% drop out before completing treatment. Of those who do respond to treatment, only about half show more than a 30% improvement.
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.