Exposure and Response Prevention
for Obsessive-Compulsive Disorder
Status: Strong Research Support
Exposure and Response Prevention (EX/RP) involves two components: 1) provoking obsessions and maintaining the subsequent anxiety, and 2) refraining from engaging in rituals. The purpose of this process is to allow the patient to habituate to the obsession-related anxiety; thus, the contingency between the obsessions and compulsions is weakened, and the patient learns that anxiety resulting from the obsession will habituate on its own. Exposures are conducted hierarchically, with less feared stimuli presented first. Exposure may be conducted imaginally or in vivo. Imaginal exposure often focuses on the feared consequences of obsessions. For example, a woman who performs counting rituals to neutralize obsessions about accidentally killing her husband may be asked to vividly imagine killing her husband, while refraining from counting. In vivo exposure involves bringing the patient into the actual presence of feared stimuli. For example, a patient with contamination fears may be asked to sit on the bathroom floor for a specified amount of time, without washing his/her hands or taking a shower. EX/RP is often conducted in conjunction with cognitive therapy techniques. EX/RP typically lasts 12 to 16 sessions; although it is probably often provided on a once-weekly basis, it can be delivered more frequently (e.g., daily or twice-weekly).
Key References (in reverse chronological order)
Franklin, M.E., Abramowitz, J.S., Kozak, M.J., Levitt, J.T., & Foa, E.B. (2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68, 594-602.
Abramowitz, J. S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. Journal of Consulting and Clinical Psychology, 65, 44-52.
Van Oppen, P., de Haan, E., Van Balkom, A. J. L. M., & Spinhoven, P. (1995). Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behaviour Research and Therapy, 33, 379-390.
Foa, E. B., Steketee, G., Grayson, J. B., Turner, R. M., & Latimer, P. (1984). Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects. Behavior Therapy, 15, 450-472.
Foa, E. B., Steketee, G. S., Milby, J. B. (1980). Differential effects of exposure and response prevention in obsessive-compulsive washers. Journal of Consulting and Clinical Psychology, 48, 71-79.
Foa, E. B., Steketee, G. Turner, R. M., & Fischer, S. C. (1980). Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers. Behaviour Research and Therapy, 18, 449-455.
Foa, E. B. & Wilson, R. (2001). Stop obsessing! (Revised Edition). New York: Bantam Books.
Steketee, G.S. (1996). Treatment of Obsessive Compulsive Disorder (Treatment Manuals For Practitioners). New York: Guilford.
The Center for Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia, PA offers workshops on EX/RP.
The American Institute of Cognitive Therapy in New York City offers workshops in treatment of OCD, using elements of both cognitive therapy and exposure and response prevention.
The Association for Behavioral and Cognitive Therapies has previously offered workshops with training in exposure therapy for OCD at its annual conference.