PSYCHOSOCIAL TREATMENT OF OBSESSIVE-COMPULSIVE DISORDER

Although progress is being made in the application of cognitive therap y to obsessive-compulsive disorder (OCD), behavior therapy, especially exposure and response prevention, is currently the nonpharmacological treatment of choice. The behavioral model of OCD states that obsessiv e fears give rise to anxiety. This anxiety is then reduced by compulsi ve behaviors, which are thus maintained by negative reinforcement. Whi le the model falls short of explaining the acquisition of obsessions, it does give an adequate account of the maintenance of compulsive beha viors. For the most part, behavior therapy has been at least as effect ive as medication and shows lasting benefits at follow up. Impediments to progress in treatment include noncompliance, severe depression, pe rsonality disorders and overvalued ideas. Treatment guidelines for beh avior therapy are presented In the cognitive model of OCD, automatic t houghts involving overestimated perceived personal responsibility and exaggerated perceived threat lead to anxiety; compulsive rituals funct ion to reduce this anxiety. The effectiveness of cognitive therapy in the treatment of OCD is assessed and some treatment guidelines are pro vided Although behavior therapy is the treatment of choice for OCD, pa tients can benefit from the addition of antidepressant medication or c ognitive therapy, at least during the initial stages of treatment.