Behavior Therapy | Cognitive Therapy | Psychodynamic Psychotherapy
In 1966, Meyer reported the successful behavioral
treatment of two patients with severe compulsive ritualizing through
around-the-clock response (or ritual) prevention. A series of elegant studies
by other investigators (Foa et al. 1998; Marks et al. 1975; Rachman et al. 1973; Steketee et al. 1982) confirmed that approximately 75% of
OCD patients will engage in behavior therapy and that most who do
so faithfully show both acute (Foa et al. 1998) and
sustained (O'Sullivan et al. 1991) improvement.
Unsuccessful treatment is most often a result of noncompliance,
which may take the form of unrecognized mental rituals. Comorbid
severe depression, misdiagnosis (e.g., when psychotic delusions
are misinterpreted as obsessions), and state-dependent learning
(usually associated with high doses of central nervous system [CNS] depressant
substances such as alcohol, barbiturates, carbamates, or benzodiazepines)
also interfere with response to behavior therapy. Wolpe's (1958) systematic desensitization was found to have weak
efficacy for patients with OCD (Cooper et al. 1965).
Relaxation did not increase the benefit of effective exposure and
ritual prevention, and exposure in fantasy or imagination was not
as effective as exposure in vivo (Steketee et al. 1982).