Behavioral treatment of obsessive-compulsive neurosis

Three chronic and severe obsessive-compulsive neurotics were treated with behavioral intervention strategies and psychotropic medication. The effects of treatment were evaluated in three separate experiments with single case experimental designs. The results suggest that response prevention was effective in reducing ritualistic behavior while the effects of flooding and antidepressant medication added little to outcome. The results also suggest that strategies aimed only at reducing compulsive behavior per se are insufficient in eliminating other associated difficulties (e.g., depressive symptoms, interpersonal problems) and that a comprehensive approach to treatment is needed.     

A behavioural interpretation of obsessive-compulsive neurosis

Criticism by family and friends is a powerful means of eliminating socially undesirable habits, but it is liable to fail if the action in question is subject to undelayed reinforcement. The agent then claims that he is under “compulsion” to act as he does. The effect of the criticism is to add a sympathetic component to the compulsive behaviour, and if the agent admits the justice of the criticism, the emotion associated with this sympathetic response is “guilt”. The appropriate treatment is to subject the compulsive habit to negative reinforcement. Successful treatment of a case of trichopilomania is described. The patient, a woman of 40, had been plucking out her eyebrows compulsively for a period of 31 years. She was instructed to arrest at its commencement each movement of her hand to her forehead for the purpose of plucking. Cure was essentially complete in ten days. Three months later the eyebrows were fully grown and, contrary to deductions from psychoanalytic theory, no substitute symptoms had developed. A prediction, drawn from the author's behavioural theory of perception, that an itch in the brows that had always preceded plucking would disappear with the extinction of the compulsive habit, was confirmed.     

Problems with stimulus/response equivalence and reactivity in the assessment and treatment of obsessive-compulsive neurosis

Self-recording was used as part of a comprehensive package of interventions to treat a case of obsessive-compulsive neurosis. The discrepancy between the self-recording data and other indices of improvement provoked consideration of the value of self-monitoring in light of Rachman's (1976) typology of obsessive-compulsives and the three major theoretical explanations of the reactivity of self-monitoring (Nelson and Hayes, 1981). It is hypothesized that self-monitoring may be countertherapeutic and misleading when there is stimulus/response equivalence or a checker type of obsessive-compulsive client.     

Danger ideation reduction therapy for obsessive-compulsive checking: preliminary findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive-compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive-compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.     

Venlafaxine treatment of obsessive-compulsive disorder: case reports

About one-third of patients affected by obsessive-compulsive disorder fail to respond to serotonergic drugs and different strategies have been proposed for these resistant cases. This article reports experiences with venlafaxine in patients with obsessive-compulsive disorder who did not respond or did not tolerate serotonergic drugs.     

Successful treatment of obsessive-compulsive disorders

Behavioral therapy and drugs have significantly improved obsessive-compulsive disorder (OCD) symptoms. A variety of behavioral therapy methods have been employed, but exposure and prevention of response, particularly, have reduced ritualistic actions of many OCD patients. Many psychoactive drugs have been tried; the tricyclic antidepressant drugs (clomipramine or Anafranel), especially in research outside the United States, have alleviated OCD symptoms as well as depression. Compulsive rituals have responded more often than obsessive actions to both behavioral and psychopharmacological therapy. Recent research has suggested that psychophysiological as well as traditional psychogenic factors may contribute to the etiology, course, and alleviation of OCD.     

Home-based treatment of obsessive-compulsive patients: intersession interval and therapist involvement

In a 2 x 2 factorial design massed vs spaced and therapist vs self-controlled exposure were compared with obsessive-compulsive patients. Intersession interval was varied keeping constant the length of exposure time and number of exposure sessions. Treatment in all conditions was home based. Treatment led to highly statistical and significant improvements on all measures. Massed exposure was as effective as spaced exposure; self-controlled exposure proved to be as effective as therapist-controlled exposure.     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.     

The effects of flooding on reducing snake fear in rhesus monkeys: 6-month follow-up and further flooding

Seven wild-reared rhesus monkeys were given two different 6-month follow-up tests to assess for spontaneous recovery of snake fear that had been somewhat reduced following 7 flooding sesions 6 months earlier. Both tests revealed essentially complete spontaneous recovery of fear. In addition, all 7 monkeys received 4 further mixed flooding sessions that involved exposure to real, toy and model snakes, and the 4 most fearful monkeys also received 3 more hours of exposure to the real snake alone. A final behavioral test following these additional flooding sessions revealed a pattern of changes very similar to that observed after the original 7 sessions 6 months earlier. In particular, there were some significant changes in the behavioral avoidance component of the fear but no changes in the behavioral disturbance component of the fear. The results are discussed in the context of earlier studies that purported to demonstrate that snake fear is easy to abolish. It is concluded that these earlier studies erred by not having tests for spontaneous recovery and by only testing for changes in the behavioral avoidance component of fear. Possible reasons for the failure to produce significant changes in the behavioral disturbance component of fear are discussed.     

Family treatment of an obsessive-compulsive child: a case report

This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.     

Child psychoanalysis and obsessive-compulsive symptoms: the treatment of a ten-year-old boy

Obsessive-compulsive symptoms have long held interest for psychoanalysts. Currently, pharmacological and behavioral treatments are commonly viewed as the standard of care, and psychoanalytic clinicians are often uncertain of how best to approach these patients. The successful two-year psychoanalytic treatment of a ten-year-old boy with obsessivecompulsive disorder, who remained symptom-free eight years after termination, is reported. While this is but a single case, its outcome implies that for some patients psychoanalysis may be the treatment of choice.