Academic journal article Journal of Cognitive Psychotherapy

Effectiveness of Cognitive Therapy for Obsessive-Compulsive Disorder: An Open Trial

Academic journal article Journal of Cognitive Psychotherapy

Effectiveness of Cognitive Therapy for Obsessive-Compulsive Disorder: An Open Trial

Article excerpt

This study examined the effectiveness of a new type of purely Beckian cognitive treatment for Obsessive-Compulsive Disorder (OCD). The manualized treatment used a flexible format permitting therapists to choose among several modules developed to address specific OCD belief domains identified by the Obsessive-Compulsive Cognition Working Group (1997). Fifteen participants diagnosed with OCD were treated individually for 14 weekly sessions. Ten participants had never received behavior therapy, and 5 participants had failed to benefit from exposure and response prevention (ERP) in the past. Participants improved with respect to their depressive and obsessive-compulsive symptoms over the course of the treatment. However, those who had never received ERP improved more than those who had failed to benefit from prior ERP. Implications of the study are discussed.

Keywords: obsessive-compulsive disorder; cognitive therapy; anxiety disorders

The behavioral treatment of exposure with response prevention (ERP) is considered the psychological treatment of choice for obsessive-compulsive disorder (OCD). ERP consists of extended exposure to anxiety-provoking situations combined with prevention of rituals. Studies show that about 63% of OCD patients respond favorably to ERP (Stanley & Turner, 1995), but approximately 20% to 30% are resistant to ERP or refuse it, reluctant to undergo the anxiety-provoking exposures (e.g., Foa, Franklin, & Kozak, 1998). Moreover, ERP may be less effective for patients with predominantly covert (mental) rituals (e.g., Rachman, 1997). Exposure exercises typically last for 90 minutes and are completed in real-life settings such as public bathrooms or the patient's home (see Foa et al., 1998). However, therapists in many practice contexts and managed care settings are unwilling or unable to schedule sessions outside their office for longer than 1 hour. Thus, although considered to be the primary treatment for OCD, ERP has limitations.

Cognitive therapy (CT) approaches for OCD are potentially as effective as ERP (for a review, see Abramowitz, 1997). Trials by van Oppen and colleagues (1995) and Cottraux and colleagues (2001) with moderately large samples indicated that CT and ERP produced comparable benefits. In van Oppen and colleagues' trial, 57% of CT patients were rated "recovered" and 75% were "reliably changed." Cottraux and colleagues reported that 74% of CT patients responded to treatment and that CT was more effective in reducing depression.

The CT methods used in the studies described above were based on cognitive models of OCD. Salkovskis (1989) proposed that what distinguishes people with OCD is not the experience of intrusive thoughts, but how they are appraised. Whereas most people simply ignore these thoughts, OCD sufferers pay attention to them and believe them to be important. Rachman (1997) and Freeston, Rhéaume, and Ladouceur (1996) further elaborated this model. These models propose that negative interpretations of an intrusion ("I'm a bad person for having this thought") lead to negative emotions which, in turn, provoke efforts to neutralize them with compulsions or other discomfort-reducing activities. Consonant with these models, six domains of beliefs were identified by an international group of researchers as particularly relevant to OCD (Obsessive Compulsive Cognition Working Group [OCCWG], 1997): inflated responsibility, overestimation of threat, overimportance of thoughts, need to control thoughts, need for certainty, and perfectionism.

In the present study, we tested the effectiveness of a manualized Beckian CT for OCD without prolonged exposure and prevention of rituals. Treatment addressed patients' maladaptive beliefs related to cognitive domains identified as problematic for OCD. The therapist selected relevant treatment modules, each describing cognitive interventions for the cognitive domains that matched the patients' beliefs. Our treatment differs from the CT used in the previous studies by including more cognitive domains than did van Oppen and colleagues (1995), who focused on overestimation of danger and inflated responsibility, and Cottraux and colleagues (2001), who included these two domains plus thought-action fusion, a component of overimportance of thoughts. …

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