ABSTRACT

Once considered to be a treatment-refractory condition, obsessive-compulsive disorder (OCD) has begun to yield to the application of new and improved treatments. As discussed in preceding chapters, treatments have evolved along two relatively independent lines. The first is the pharmacological, through the synthesis of serotonin reuptake inhibitors (SRls) that possess anti-obsessional and anticompulsive properties, including clomipramine (Clomipramine Collaborative Study Group, 1991; Leonard et al., 1991; Leonard et al., 1989; Pigott et al., 1990), fluvoxamine (Freeman, Trimble, Deakin, Stokes, & Ashford, 1994; Goodman, Price, Rasmussen, Delgado, et al., 1989; Rasmussen et al., in press), and fluoxetine (Levine, Hoffman, Knepple, & Kenin, 1989; Pigott et al., 1990; Tollefson et al., 1994). The second is the psychosocial, primarily through the perfection of therapies that incorporate the procedures of in vivo exposure and response prevention (ERP) either as the principal therapeutic intervention (Baer & Minichiello, 1990; Faa, Steketee, & Ozarow, 1985; O'Sullivan & Marks, 1991; Steketee, 1993) or in conjunction with cognitive restructuring (Emmelkamp & Beens, 1991; van Oppen et al., 1995). Both approaches have enjoyed a substantial degree of success, so that most patients who engage in therapy now can expect to experience clinically significant hnprovement. Unfortunately, improvement generally is modest, and there e:dsts a sizable minority of patients who either cannot tolerate a given treatment or fail to respond to it. Possibly because of the limitations of each individual treatment, the belief has grown among clinicians that a

combination of drug and psychosocial therapies is the best treatment for OCD (Greist, Jefferson, Kobak, Katzelnick, & Serlin, 1995).