What’s Broken with Cognitive Behavior Therapy Treatment of Obsessive–Compulsive Disorder and How to Fix It

Cognitive Behavior Therapy (CBT) is the evidence–based treatment of choice for Obsessive–Compulsive Disorder (OCD). The central technique of this approach is Exposure and Response Prevention (EX/RP). Examination of EX/RP treatment of OCD reveals severe shortcomings. The technique, while generally quite effective, cannot deal with patients who are unable to comply with EX/RP’s difficult regime, resulting in a significant percentage of patients who refuse treatment and dropouts. Also, for optimal results, the therapist should be present while the patient carries out EX/RP therapy. This severely reduces the therapist’s resources since leaving the clinic and being personally present during EX/RP in the patient’s real life circumstances is not something therapists can do easily. These limitations acutely compromise the applicability of this technique to clinical practice. Research into Cognitive Therapy without EX/RP does not show superiority to EX/RP. In this paper, I illustrate a Strategic/Behavioral Treatment (SBT) for OCD that easily and elegantly overcomes the limitations of Cognitive Behavioral Therapy (CBT) treatment (thereby increasing its effectiveness), present three case studies, and offer suggestions for further research.