Review of OCD Treatments

In the latest issue of the Journal of Consulting and Clinical Psychology (1997, Vol. 65) there was an article entitled "Effectiveness of Psychological and Pharmacological Treatment of Obsessive-Compulsive Disorder: A Quantitative Review" by Jonathan A. Abramowitz. The abstract reads as follows:

"Quantitative review of the controlled treatment outcome literature for obsessive-compulsive disorder (OCD) showed that exposure with response prevention was highly effective in reducing OCD symptoms. Cognitive approaches were also found to be at least as effective as exposure procedures. It appears that both cognitive and exposure interventions involve some overlapping procedures and capitalize on similar mechanisms of change. Serotonergic medication, particularly clomipramine, also substantially reduced OCD symptoms. However, clomipramine may not be particularly superior to other serotonergic medication. The relationship between side effects and effect size in medication trials was explored."

My own understanding is that distinctions between cognitive and behavioral approaches to OCD are more a matter of emphasis than anything else. Some cognitive restructuring (whether formal or informal) is necessary to get patients to the point where they are willing to engage in exposure and response prevention. And I am not aware of any cognitive therapist who treats OCD without including exposure and response prevention (whether done in vivo or done as homework assignments). Clinically, these treatments are effective - but, they certainly involve long, hard work! What types of experiences have other clinicians been having with their OCD patients?

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