Hostname: page-component-5c6d5d7d68-qks25 Total loading time: 0 Render date: 2024-08-07T11:34:37.998Z Has data issue: false hasContentIssue false

Cognitive-Behavioral Therapy and Integrated Approaches in the Treatment of Obsessive-Compulsive Disorder

Published online by Cambridge University Press:  07 November 2014

Abstract

Obsessive-compulsive disorder (OCD) has long been considered a treatment-refractory mental condition. Neither pharmacologic nor psychodynamic therapy has been proven to treat OCD effectively. Yet the prognosis for OCD has changed dramatically in recent years with the introduction of behavior therapy and the use of selective serotonin reuptake inhibitors (SSRIs). Many studies have shown that behavior therapy, especially exposure with response prevention, and SSRIs reduce obsessive-compulsive symptoms significantly. Still, many unanswered questions—including the role of cognitive therapy in the treatment of OCD, exposure therapy vs multimodal behavioral therapy, individual versus group therapy, outcome predictors in adults, adolescents, and children, and the role of combination treatment using an SSRI and cognitive-behavioral therapy—remain. This article will explore these issues as well as suggest directions for further research into OCD.

Type
Academic Supplement Monograph
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Greist, JH. Treatment of obsessive compulsive disorder: psychotherapies, drugs, and other somatic treatment. J Clin Psychiatry. 1990;51:4450.Google ScholarPubMed
2.Marks, I. Fears, Phobias and Rituals. Oxford, England: Oxford University Press; 1987.Google Scholar
3.Foa, EB, Kozak, MJ. Psychological treatment for obsessive-compulsive disorder. In: Mavissakalian, MR, Prien, RF, eds. Long-term Treatments of Anxiety Disorders. Washington, DC: American Psychiatric Press; 1996.Google Scholar
4.Greist, JH, Jefferson, JW. Pharmacotherapy for obsessive-compulsive disorder. Br J Psychiatry. 1998;173:6470.CrossRefGoogle Scholar
5.Christensen, H, Hadzi-Pavlovic, D, Andrews, G, Mattick, R. Behavior therapy and tricyclic medication in the treatment of obsessive-compulsive disorder: a quantitative review. J Consult Clin Psychol. 1987;55:701711.CrossRefGoogle ScholarPubMed
6.Cox, BJ, Swinson, RP, Morrison, B, Lee, PS. Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-compulsive disorder: a meta-analysis. J Behav Ther Exp Psychiatry. 1993;24:149153.CrossRefGoogle ScholarPubMed
7.van Balkom, AJ, van Oppen, P, Vermeulen, AW, van Dyck, R, Nauta, MC, Vorst, HC. A meta-analysis on the treatment of obsessive-compulsive disorder: comparison of antidepressants, behavior, and cognitive therapy. Clin Psychol Rev. 1994;5:359381.CrossRefGoogle Scholar
8.Pato, MT, Zohar-Kadouch, R, Zohar, J, Murphy, DL. Return of symptoms after discontinuation of clomipramine in patients with obsessive-compulsive disorder. Am J Psychiatry. 1988;145:15211525.Google ScholarPubMed
9.Pato, MT, Murphy, DL, DeVane, CL. Sustained plasma concentrations of fluoxetine and/or norfluoxetine four and eight weeks after fluoxetine discontinuation. J Clin Psychopharmacol. 1991;11:224225.CrossRefGoogle ScholarPubMed
10.Hand, I. Out-patient, multi-modal behaviour therapy for obsessive-compulsive disorder. Br J Psychiatry. 1998;173:4552.CrossRefGoogle Scholar
11.Salkovskis, PM, Forrester, E, Richards, C. Cognitive-behavioral approach to understanding obsessional thinking. Br J Psychiatry. 1998;173:5363.CrossRefGoogle Scholar
12.Rachman, SJ, Hodgson, RJ. Obsessions and Compulsions. Englewood Cliffs, NJ: Prentice Hall; 1980.Google Scholar
13.Rachman, SJ. Obsessions, responsibility and guilt. Behav Res Ther. 1993;31:149154.CrossRefGoogle ScholarPubMed
14.Salkovskis, PM, Richards, C, Forrester, E. The relationship between obsessional problems and intrusive thoughts. Behav Cog Psychother. 1995;23:281299.CrossRefGoogle Scholar
15.Salkovskis, PM, Westbrook, D. Behaviour therapy and obsessional ruminations: can failure be turned into success? Behav Res Ther. 1989;27:149160.CrossRefGoogle ScholarPubMed
16.Roth, AD, Church, JA. The use of revised habituation in the treatment of obsessive-compulsive disorders. Br J Clin Psychol. 1994;33:201204.CrossRefGoogle ScholarPubMed
17.Freeston, MH. Characteristics and Treatment of Obsessions Without Overt Compulsions. Quebec, Canada: School of Psychology, University of Laval; 1994. Thesis.Google Scholar
18.Schwartz, JM. Neuroanatomical aspects of cognitive behavioural therapy response in obsessive-compulsive disorder. Br J Psychiatry. 1998;173:3844.CrossRefGoogle Scholar
19.Schwartz, JM. Brain Lock: Free Yourself from Obsessive-Compulsive Behavior. New York, NY: Harper Collins; 1996.Google Scholar
20.Schwartz, JM. Cognitive-behavioral self-treatment for obsessive-compulsive disorder systematically alters cerebral metabolism: a mind-brain interaction paradigm for psychotherapists. In: Hollander, E, Stein, DJ, eds. Obsessive-Compulsive Disorders: Diagnosis, Etiology, Treatment. New York, NY: Marcel Dekker Inc; 1997.Google Scholar
21.Schwartz, JM, Stoessel, PW, Baxter, LR, et al.Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:109113.CrossRefGoogle ScholarPubMed
22.James, IA, Blackburn, I-M. Cognitive therapy with obsessive-compulsive disorder. Br J Psychiatry. 1995;166:444450.CrossRefGoogle ScholarPubMed
23.van Oppen, P, De Haan, E, Van Bakon, A. Cognitive therapy and exposure in vivo in the treatment of obsessive-compulsive disorder. Behav Res Ther. 1995;33:379390.CrossRefGoogle ScholarPubMed
24.Cottreaux, J, Note, I, Dartigues, JF. A multicenter controlled trial of cognitive therapy vs intensive behavior therapy. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
25.Steketee, G. Cognitive assessment and intervention for OCD: integrative effects. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
26.Keijsers, G, Hoogduin, C, Shaap, C. Predictors of treatment outcome in the behavioural treatment of obsessive-compulsive disorder. Br J Psychiatry. 1994;165:781786.CrossRefGoogle ScholarPubMed
27.Hohagen, F, Winkelmann, G, Rasche-Rauchle, H, et al.Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Br J Psychiatry, 1998;173:7178.CrossRefGoogle Scholar
28.Hermesh, H, Marom, S, Weizman, A, Munitz, H. Intensive cognitive behaviour therapy and psychopharmacology in extremely severe and resistant OCD cases. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
29.Krone, KP, Himle, JA, Nesse, RM. A standardized behavioral group treatment program for obsessive-compulsive disorder: preliminary outcomes. Behav Res Ther. 1991; 29:627631.CrossRefGoogle ScholarPubMed
30.Fals-Stewart, W, Marks, AP, Schafer, J. A comparison of behavioral group therapy and individual behavior therapy in treating obsessive-compulsive disorder. J New Ment Dis. 1993;181:189193.CrossRefGoogle ScholarPubMed
31.van Noppen, BL, Pato, MT, Marsland, R, Rasmussen, SA. A time-limited behavioral group for treatment of obsessive-compulsive disorder. J Psychother Pract Res. 1998;7:272280.Google Scholar
32.Pato, MT. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
33.Basoglu, M, Lax, T, Kasvikis, Y, Marks, IM. Predictors of improvement in obsessive-compulsive disorder. J Anxiety Disord. 1988;2:299317.CrossRefGoogle Scholar
34.de Haan, E, van Oppen, P, van Balkom, AJ, Spinhoven, P, Hoogduin, KA, van Dyck, R. Prediction of outcome and early vs late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy. Acta Psychiatr Scand. 1997;96:354361.CrossRefGoogle ScholarPubMed
35.Foa, EB. Failure in treating obsessive-compulsives. Behav Res Ther. 1979;17:169176.CrossRefGoogle ScholarPubMed
36.Buchanan, AW, Meng, KS, Marks, IM. What predicts improvement and compliance during the behavioral treatment of obsessive compulsive disorder? Anxiety. 1996;2:2227.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
37.Castle, DJ, Deale, A, Marks, IM, Cutts, F, Chadhoury, Y, Stewart, A. Obsessive-compulsive disorder: prediction of outcome from behavioural psychotherapy. Acta Psychiatr Scand. 1994;89:393398.CrossRefGoogle ScholarPubMed
38.Minichiello, WE, Baer, L, Jenike, MA. Schizotypal personality disorder: a poor prognostic indicator for behavior therapy in the treatment of obsessive-compulsive disorder. J Anxiety Disord. 1987;1:273276.CrossRefGoogle Scholar
39.AuBuchon, PG, Malatesta, VJ. Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy. J Clin Psychiatry. 1994;55:448453.Google ScholarPubMed
40.De Araujo, LA, Ito, LM, Marks, IM. Early compliance and other factors predicting outcome of exposure for obsessive-compulsive disorder. Br J Psychiatry. 1996;169:747752.CrossRefGoogle ScholarPubMed
41.Piancentini, J. Predictors of response to CBT for childhood OCD. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
42.Marks, I, Lelliott, P, Basoglu, M. Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. Br J Psychiatry. 1988;152:522534.CrossRefGoogle ScholarPubMed
43.Cottreaux, J, Mollard, E, Bouvard, M, et al.A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacol. 1990;5:1730.CrossRefGoogle Scholar
44.Cottreaux, J, Mollard, E, Bouvard, M, et al.Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one-year follow-up. Psychiatry Res. 1993;49:6375.CrossRefGoogle Scholar
45.Neziroglu, F. Integration of behavior therapy with medications. Presented at: Third International Obsessive Compulsive Disorder Conference, Madeira, Portugal. 1998.Google Scholar
46.Khanna, S, Kumar, R, Reddy, J. The efficacy of addition of cognitive behavior therapy to fluoxetine in the management of obsessive compulsive disorder. Paper presented at: Third International Obsessive-Compulsive Disorder Conference; September 11-12, 1998: Madeira, Portugal.Google Scholar
47.McDougle, CJ, Goodman, WK, Leckman, JF, et al.Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry. 1994;51:302308.CrossRefGoogle ScholarPubMed