Exposure and Response Prevention for Obsessive-Compulsive Disorder

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DIAGNOSIS: Obsessive-Compulsive Disorder
TREATMENT: Exposure and Response Prevention for Obsessive-Compulsive Disorder

2015 EST Status: StrongResearch Support (SEE REPORT)Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Empirical Review Status

2015 Criteria
(Tolin et al. Recommendation)

Very Strong

Strong

Weak

Insufficient Evidence

Treatment pending re-evaluation

1998 Criteria
(Chambless et al. EST)

Strong

Modest

Controversial

Find a Therapist specializing in Exposure and Response Prevention for Obsessive-Compulsive DisorderList your practice

Brief Summary

Basic premise: As individuals confront their fears and discontinue their escape response, they will eventually reduce their anxiety.
Essence of therapy: Individuals with OCD repeatedly confront the thoughts, images, objects, and situations that make them anxious and/or start their obsessions in a systematic fashion, without performing compulsive behaviors that typically serve to reduce anxiety. Through this process, the individual learns that there is nothing to fear and the obsessions no longer cause distress.
Length: approximately 12 sessions

Treatment Resources

Editors:Brian Marx, PhD; Alexandra Greenfield, MS

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals Training Resources Measures, Handouts and Worksheets Self-help Books Smartphone Apps Video Demonstrations Video Descriptions Clinical Trials Meta-Analyses and Systematic Reviews Other Treatment Resources

Treatment Manuals / Outlines

Treatment Manuals

Books Available for Purchase Through External Sites

Treatment of Obsessive Compulsive Disorder (Steketee)
Exposure and Response (Ritual) Prevention for Obsessive-Compulsive Disorder: Therapist Guide (Foa, Yadin, & Lichner)

Training Materials and Workshops

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.
The Beck Institute in Philadelphia, PA offers training in EX/RP.

Measures, Handouts and Worksheets

Treating Your OCD with Exposure and Response (Ritual) Prevention Therapy: Workbook (Yadin, Foa, & Lichner)
Obsessive-Compulsive Inventory – Revised (Foa et al.)

Self-help Books

Stop Obsessing!: How to Overcome Your Obsessions and Compulsions (Revised Edition) (Foa & Wilson)

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

Live OCD Free is designed to guide users through ExRP for OCD.

Clinical Trials

Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: A randomized clinical trial (Simpson et al., 2013)
Six-month follow-up of a randomized controlled trial augmenting serotonin reuptake inhibitor treatment with exposure and ritual prevention for obsessive-compulsive disorder (Foa et al., 2013)
Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples (Franklin et al., 2000)
Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder (van Oppen et al., 1995)
Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects (Foa et al., 1984)
Differential effects of exposure and response prevention in obsessive-compulsive washers (Foa, Steketee, & Milby, 1980)
Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers (Foa et al., 1980)

Meta-analyses and Systematic Reviews

Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review (Abramowitz, 1997)

DIAGNOSIS: Obsessive-Compulsive Disorder TREATMENT: Exposure and Response Prevention for Obsessive-Compulsive Disorder

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators. Modest: Support from one well-designed study or several adequately designed studies. Controversial: Conflicting results, or claims regarding mechanisms are unsupported.