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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
The behavioral treatment of OCD involves prolonged exposure to fear-producing stimuli and the active blocking of associated compulsive behaviors. Exposure, in this context, refers to treatment that involves confrontation with fear-producing stimuli. The various strategies used to engineer such exposure reflect different theoretical notions regarding the nature of fear reduction. The goal of exposure treatment is the elimination of maladaptive anxiety, intrusive obsessional thoughts, and associated ritualistic behaviors. Exposure treatments can be divided along two dimensions. The first dimension pertains to whether exposure is administered in an intensive or graduated fashion. In intensive exposure, the patient is exposed directly to the stimuli he or she fears most. In gradual exposure, the patient is exposed incrementally to fear-producing stimuli, building from the least to the most feared. The second dimension pertains to whether stimuli are presented imaginally or whether they occur in vivo (in real situations). In either case, the stimuli can be presented in intensive or gradual fashion. When treating patients with OCD, the most frequently used method is intensive, although graduated methods are also used. The form in which exposure therapy is implemented with any patient depends to a large extent on the clinical features of the patient and how the OCD is manifested in his or her life. Anxiety generated by obsessions (e.g., thoughts, images, impulses) typically instigates a strong internal drive to engage in compulsive and ritualized behavior that results in temporary anxiety relief. The compulsive behaviors are maintained because of their anxiety-reducing role. The target of treatment for OCD is the core fear (i.e., the catastrophic fear) that underlies the obsessions and compulsion. The core fear typically differs to some extent for each OCD patient. Each session is terminated after habituation (a 50% reduction in reactivity to fear-producing stimuli) is achieved. To eliminate rituals, the therapist uses response prevention to block compulsive ritualistic behaviors (e.g., in the case of washing rituals, the patient is "prevented" from washing). This is achieved through instruction, encouragement, direction, persuasion, and a variety of other nonphysical means. Because the rituals typically serve an anxiety-reducing function, the patient must "learn" that the feared catastrophic consequences do not occur if the rituals are not performed. Once the active treatment phase is completed, a maintenance phase involving response prevention activities can help prevent relapse. Other co-occurring conditions (such as depression, family, and work problems) may require different intervention strategies once the OCD is controlled. Dr. Turner identifies his approach as "behavior therapy." What does this imply to you? More specifically, what do you expect of him? Will Dr. Turner be active or passive? Will the session be structured or unstructured? Directive or nondirective? Will it focus on the past or on the present? Will the session focus on behaviors, on thoughts, or on feelings? What do you expect to be the relative balance between attention to technique versus the interpersonal interaction? Return to Behavior Therapy for Obsessive–Compulsive Disorder |
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