ABSTRACT
Obsessive-compulsive disorder (OCD) was once perceived as being resistant to psychological treatment, because no known treatment (e.g., insight-oriented therapy, client-centered therapy, family therapy, or play therapy) had demonstrated efficacy in decreasing symptoms. However, Meyer’s (1966) pioneering work involving the use of exposure with response prevention (E/RP) led to the development of a successful behavioral treatment for OCD. Foa and Kozak (1986) continued to build on the model and began to disseminate E/RP more widely. E/RP is based on the premise that there are functional relationships between OCD symptoms and anxiety. Specifically, obsessions are associated with increases in anxiety, which motivate compulsions in efforts to reduce anxiety. Proponents of E/RP believed that these associations could be weakened through extinction processes, and research has consistently supported the effectiveness of this approach (see Abramowitz, Whiteside, & Deacon, 2005;
Storch & Merlo, 2006; Van Balkom et al., 1994). In fact, E/RP has been recognized as a powerful empirically supported treatment for OCD (Expert Consensus Panel for Obsessive-Compulsive Disorder, 1997). However, not all patients show a clinically significant decrease in OCD symptoms following E/RP (Baer & Minichiello, 1998), and some individuals refuse E/RP treatment or drop-out due to its anxiety-provoking nature (Stanley & Turner, 1995). Others are poor candidates for various reasons (e.g., Axis II pathology, poor insight).
