Academic journal article Journal of Cognitive Psychotherapy

Modular Cognitive Therapy for Obsessive-Compulsive Disorder: A Wait-List Controlled Trial

Academic journal article Journal of Cognitive Psychotherapy

Modular Cognitive Therapy for Obsessive-Compulsive Disorder: A Wait-List Controlled Trial

Article excerpt

The current study examined the efficacy of cognitive therapy (CT) in reducing symptoms of obsessive-compulsive disorder (OCD). Twenty-nine individuals with OCD were assigned according to therapist availability to a 12-week wait period or the immediate start of 22 sessions (over 24 weeks) of flexible, modular CT. After 12 weeks of treatment, the CT group, but not the wait-list group, exhibited significant improvement in OCD symptoms. The combined sample of patients who underwent 24 weeks of CT improved significantly from pre- to posttreatment and symptoms remained significantly improved at 3-month follow-up. OCD symptoms rose slightly between posttreatment and 12-month follow-up, but, remained significantly lower than at pretreatment. Overall, modular CT appears to be an effective and acceptable treatment for OCD.

Keywords: obsessive-compulsive disorder; cognitive therapy; wait-list controlled trial; modular treatment; behavior therapy

The most commonly delivered, empirically supported treatments for obsessive-compulsive disorder (OCD) are psychopharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine and behavior therapy (BT) with exposure and response prevention techniques during which patients are repeatedly exposed to anxiety provoking stimuli and prevented from engaging in rituals. Exposure and response prevention is based on an empirically supported model that rituals decrease discomfort in the short-term but reinforce obsessive anxiety in the long-term. These treatments are unquestionably beneficial for many OCD patients (e.g., Abramowitz, 1997; Foa et al., 2005). However, not all patients respond. Additionally many OCD patients refuse or discontinue psychopharmacological treatments because they are unable or unwilling to tolerate medication side effects, and many refuse or withdraw from BT, unwilling to tolerate the time intensive and anxiety provoking exposure exercises (Franklin & Foa, 1998). Hence there is a clear need for effective and acceptable treatment alternatives for OCD. Cognitive approaches offer some promise as they may be less stressful for patients and may therefore have lower refusal rates than intensive forms of BT or pharmacotherapy. Furthermore, as they can be conducted in the therapist's office and in 50-60 minute sessions, they may be more acceptable to therapists as well as managed health care providers.

According to cognitive models of OCD (e.g., Freeston, Rhéaume, & Ladouceur, 1996; Rachman, 1997; Salkovskis, 1989), intrusive thoughts are normal phenomena experienced universally by people with and without OCD (e.g., Rachman & de Silva, 1978). What distinguishes people with OCD from those without is not the experience of intrusive thoughts per se, but rather, OCD patients' beliefs about the presence or significance of intrusive thoughts. Whereas most people simply dismiss intrusive thoughts as transient and unimportant, individuals with OCD ascribe inordinate importance to them. The belief that intrusive thoughts are dangerous generates great anxiety and provokes compensatory rituals to reduce the likelihood of perceived danger or avoidance of situations that might trigger intrusive thoughts.

As described in standard texts on cognitive therapy (e.g., Beck, 1995; Wells, 1997), cognitive therapists help patients identify and modify distorted beliefs. Using techniques such as Socratic questioning, therapists assist patients in evaluating the validity and the utility of abiding by their beliefs that engender anxiety, compulsions, and avoidance behaviors. Within the context of belieffocused work, therapists occasionally ask patients to conduct behavioral experiments, designed to test their distorted hypotheses about what might happen were they to refrain from ritualizing. Such experiments are brief and only done to illustrate a particular point, such as testing whether a negative prediction comes true and are one of many CT strategies. …

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