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Although general cognitive behavioural therapy (CBT) can help alleviate distress associated with obsessive-compulsive disorder (OCD), strategies tailored to targeting specific cognitions, feelings, and behaviours associated with OCD such as exposure and ritual prevention (Ex/RP) and cognitive therapy (CT) have been shown to be a significantly more effective form of treatment. Treatment of individuals with unacceptable/taboo obsessions requires its own specific guidelines due to the stigmatizing and often misunderstood nature of accompanying thoughts and behaviours. In this article, OCD expert practitioners describe best practices surrounding two of the longest standing evidence-based treatment paradigms for OCD, CT and Ex/RP, tailored specifically to unacceptable and taboo obsessions, so that clients may experience the best possible outcomes that are sustained once treatment ends. In addition, CT specifically targets obsessions while Ex/RP addresses compulsions, allowing the two to be highly effective when combined together. A wide range of clinical recommendations on clinical competencies is offered, including essential knowledge, psychoeducation, designing fear hierarchies and exposures, instructing the client through behavioural experiments, and relapse prevention skills.Key learning aims(1)To learn about the theoretical underpinnings of specialized approaches to treating taboo/unacceptable thoughts subtype of OCD with gold-standard CBT treatments, cognitive therapy (CT) and exposure and ritual prevention (Ex/RP).(2)To learn about recognizing and identifying commonly missed covert cognitive symptoms in OCD such as rumination and mental compulsions.(3)To learn how to assess commonly unrecognized behavioural symptoms in OCD such as concealment, reassurance seeking, searching on online forums, etc.(4)To gain a nuanced understanding of the phenomenology of the taboo/unacceptable thoughts OCD subtype and the cycles that maintain symptoms and impairment.(5)To learn about in-session techniques such as thought experiments, worksheets, fear hierarchies, and different types of exposures.

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.

We evaluated a novel, empirically-based cognitive therapy for compulsive checking - a common form of obsessive-compulsive disorder. Twelve adults completed 12 sessions of the therapy. Significant reductions in checking-related symptoms were found pre- to post-treatment, and pre-treatment to 6-month follow-up (moderate to large effect sizes). Participants reported high treatment acceptability after the third session, which was maintained at post-treatment. This pilot trial provides preliminary support for treating compulsive checking using this novel cognitive approach.

Increased immigration requires successful interaction of different cultures in various life domains, such as health. This study investigates acculturation orientation (AO) of immigrant patients and doctors native to the country, as a potential factor related to perceived medical advice adherence. N = 171 immigrant patients (M = 54.38 years, SD = 17.94, range = 23–96, 74.3 % female) and their N = 12 doctors (M = 38.88 years, SD = 13.42, range = 27–66, 83 % female) from a hospital in Montreal, Canada, participated in a paper-based survey to assess AOs, patients’ perceived expectations of their doctor (regarding adopting the new culture or keeping their previous culture), doctors’ actual expectations, perceived quality of care and perceived adherence. AO of patients significantly related to perceived adherence, via a path model involving perceptions of doctors’ expectations and perceived quality of care. Integration was positively related to perceived adherence, while Marginalization was negatively related to it. Doctors’ AOs were not significant. Patient perceptions seem to be a significant factor to be considered when striving to improve immigrant medical advice adherence.

Background and objectives The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. Methods Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. Results Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. Limitations The small sample size limits our ability to generalize our results. Conclusions Results are discussed in terms of a focus on the timing of change in cognitive therapy.

Aims: To investigate the effects of a theory-based treatment (active control condition) addressing social-cognitive constructs on healthy lifestyle behaviors, and whether additional effects would occur if additional practical exercises with yoga, meditation, and homework to improve self-regulatory strategies (intervention condition) were added. Study Design: Pilot study. Place and Duration: An international university in Germany, four weeks. Methodology: 23 undergraduate students were allocated either to an active control group (sessions addressing social-cognitive constructs, with no yoga, meditation, or homework) or an intervention group (sessions addressing social-cognitive constructs, with additional practical exercise in yoga and meditation, and homework to increase self-regulation). Students participated in weekly sessions over four weeks. All study participants improved in their self-regulatory skills (pros, subjective norm, self-efficacy, goal setting and cons). Effects on sleep problems transpired as an interaction of time and treatment group Original Research Article British Journal of Education, Society & Behavioural Science, 4(12): 1687-1702, 2014 1688 (Eta2=.13). The intervention increased self-regulatory strategies more than the active control treatment (Eta2=.17). Conclusion: Results highlight the importance of exercising yoga and meditation, and providing additional material to enhance self-regulatory strategies. By doing so, sleep problems in students can be reduced.

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.

Cognitive-behavioral therapies for anxiety disorders are highly efficacious (e.g., Butler, Chapman, Forman, & Beck, 2006; Deacon & Abramowitz, 2004). These treatments nevertheless remain underutilized and difficult to access for many of the patients who suffer from these conditions (e.g., Norton & Hope, 2005). We identify various barriers to the wide-scale dissemination of these treatments, including those that are applicable to empirically supported treatments more generally (e.g., lack of training opportunities, failure to address practitioner concerns) as well as those that may be relatively specific to CBT for anxiety disorders (e.g., practitioner concerns around using exposure interventions). We offer suggestions for overcoming these barriers, including specific guidance about continued accumulation of a supportive research base, making the appeals that are necessary to obtain required funding and organizational support, and the training of practitioners to deliver these treatments. Advocates of CBT for anxiety disorders will need to demonstrate that these treatments are cost effective, if wide-scale dissemination is to occur. In the United States, advocacy with third party payers will also be necessary. Although providing such steps may prove to be a difficult endeavour, the patients who stand to benefit from this work deserve nothing less.

Contemporary cognitive treatment of obsessive-compulsive disorder (OCD) dates back to 1985, and rests on the premise that infrequent unwanted intrusions are essentially universal. As such, it is not the intrusion that is the focus of treatment but rather the interpretation or appraisal placed upon the intrusion. A number of cognitive domains are thought to be key areas, including inflated responsibility, overimportance of thoughts, need to control thoughts and overestimation of threat. Cognitive treatment of OCD is idiographic owing in part to the heterogeneous nature of the disorder as well as the cognitive domains implicated in the etiology and maintenance of the disorder. Cognitive treatment of an individual with ego-dystonic sexual and aggressive intrusions is illustrated in the current manuscript. Video clips are embedded at key moments during the treatment to ideally facilitate the illustration of this complex treatment. It is hoped that the addition of video clips will aid in the dissemination of this treatment that was recently tested and found to produce large effect sizes in a recent randomized controlled trial.

This article presents the case of a 51-year old woman with obsessive-compulsive disorder. “Caroline” reported obsessions of harming people secondary to spreading her “bad energy,” which is experienced as dust on her hands and in her mouth. To prevent harm coming to others she mentally “vacuums” the dust, creates mental protective barriers around nearby people and avoids touching others for fear of transmitting her bad energy. Although she reported a childhood onset of obsessions and compulsions, it exacerbated in the context of multiple stressors 4 years prior to seeking treatment. Her Yale-Brown Obsessive Compulsive Scale total score was in the moderate range at intake. Predisposing, precipitating, and maintaining factors are described in addition to the specific symptom presentation.

Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward.

This study examined the relationship between perfectionism, as measured by the Multidimensional Perfectionism Scale (MPS; [R. O. Frost et al. (1990) Cognitive Therapy and Research, 14, 449–468], and treatment outcome in obsessive compulsive disorder (OCD). Patients (n = 118) participated in group [McLean et al. (2001) Journal of Consulting and Clinical Psychology, 69, 205–214] or individual [Whittal et al. (2005) Behaviour Research and Therapy, 43, 1559–1576] cognitive therapy (CT) or exposure and response prevention (ERP) for OCD. Doubts about Actions (DA), a subscale of the MPS, uniquely predicted worse treatment outcome in the Yale-Brown Obsessive-compulsive Scale (YBOCS; [Goodman et al. (1989) Archives of General Psychiatry, 40, 1006–1011]) total score and compulsions subscale. Interactions between Concern over Mistakes (CM; another MPS subscale) and DA, as well as DA alone, predicted poorer treatment outcome in patients who received ERP. Contrary to expectations, MPS total score was not related to treatment response. Moreover, levels of perfectionism did not change over the course of treatment, regardless of the type of treatment received. Implications for treatment in OCD are discussed.

This review attempts to integrate information and methods from CBT, family therapy and pharmacotherapy orientations, in the treatment of six adult anxiety disorders, and separation anxiety in pediatrie populations. Anxiety disorders have been under-recognized and undertreated, in part because practitioners of different orientations have too often worked in isolation from one another. Both CBT and pharmacotherapy are evidence-supported treatments. However, the effectiveness of CBT can be enhanced if it is provided within a family therapy context. Similarly, medications can be an important treatment partner in the management of anxiety disorders.

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

The psychological treatment of choice for obsessive-compulsive disorder (OCD) has been behavioral in nature, that is, mainly exposure and response prevention (ERP). Recent advances and interest in cognitive therapy, largely spurred by the theoretical paper of Salkovskis in 1985, led to the development of cognitively focused approaches for the treatment of OCD. Although ERP has strong empirical support for its efficacy, cognitive interventions are receiving mounting evidence. Combining cognitive and behavioral techniques to match with a patient’s unique symptom presentation may help maximize treatment outcomes and patient satisfaction. The purpose of this article is to introduce the cognitive-behavioral theory, assessment, and treatment strategies for OCD, and to illustrate their use in the case of an individual with compulsive checking behaviors. [Brief Treatment and Crisis Intervention 3:201–215 (2003)]

In this report we describe the outcome of eight outpatients with panic disorder and agoraphobia who discontinued their treatment with a selective serotonin reuptake inhibitor (SSRI) in the context of a structured, group program of cognitive-behavior therapy. All patients successfully discontinued their SSRI medication while demonstrating clinical improvement. These results were maintained at 3-month follow-up. This case series suggests that manualized CBT for discontinuation of benzodiazepine treatment for panic disorder may be successfully applied to SSRI discontinuation as well.

In 1995 the Obsessive Compulsive Cognitions Working Group initiated a collective process to develop two measures of cognition relevant to current cognitive-behavioural models of OCD. An earlier report (Behav. Res. Therapy, 35 (1997) 667) describes the original process of defining relevant domains. This article describes the subsequent steps of the development and validation process: item generation, scale reduction, and initial examination of reliability and validity. Two scales were developed. The Obsessive Beliefs Questionnaire consists of 87 items representing dysfunctional assumptions covering six domains: overestimation of threat, tolerance of uncertainty, importance of thoughts, control of thoughts, responsibility, and perfectionism. The Interpretation of Intrusions Inventory consists of 31 items that refer to interpretations of intrusions that have occurred recently. Three of the above domains are represented: importance of thoughts, control of thoughts, and responsibility. The item reduction and validation analyses were conducted on clinical and non-clinical samples from multiple sites. Initial examination of reliability and validity indicates excellent internal consistency and stability and encouraging evidence of validity. However, high correlations indicating overlap between some of the scales, particularly importance of thoughts, control of thoughts, and responsibility will need to be addressed in subsequent empirical and theoretical investigations.

This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment.

Behavior therapy, specifically exposure plus response prevention (ERP) has been firmly established as the treatment of choice for obsessive-compulsive disorder (OCD). However, the dropout rates plus the percentage of people who do not benefit from ERP require reconsideration. For those people who do receive benefit, a considerable portion of the presenting OC symptoms remain, often necessitating further treatment. Newer cognitive-behavioral approaches that focus on challenging OCD appraisals and beliefs have been proposed as alternatives to ERP. The CBT conceptualization, rationale, and treatment strategies are described, as are the challenges. The pros and cons of conducting treatment in groups are also discussed.

Nine double-blind, placebo-controlled medication trials (870 subjects) and 26 randomized psychosocial studies (460 subjects) were included in a meta-analysis of bulimia nervosa (BN). Four treatment outcomes were analyzed: binge and purge frequency, depression (self-reported and interviewer-rated), and self-reported eating attitudes. When compared to medication, cognitive behavioral therapy (CBT) studies produced significantly larger-weighted effect sizes for all treatment outcomes. These quantitative results correspond to qualitative reviews and suggest that CBT is the treatment of choice for BN.

Twenty-four female undergraduates, 12 high on anxiety sensitivity and 12 low on anxiety sensitivity, were subjected to a hyperventilation challenge task. Physiologic and subjective measures of arousal and distress were obtained before, during, and after the hyperventilation challenge. Alternating between the eight 15-second intervals of hyperventilation, participants engaged in a heartbeat-tracking task for eight 10-second intervals to assess interoceptive acuity. Although the hyperventilation challenge produced phase main effects for physiologic arousal, and group and time main effects for subjective distress, there were no significant interaction effects. Results revealed no significant interoceptive acuity differences across the low and high anxiety sensitivity groups. However, subjective ratings of physiological sensations during hyperventilation were significantly greater for the high anxiety sensitivity group. Hierarchical multiple regression analyses revealed that anxiety sensitivity accounted for additional variance beyond trait anxiety in explaining subjective ratings of arousal and distress in this nonclinical sample in response to a hyperventilation challenge.

A brief review of biological and psychological classification systems reveals that existing taxonomies have focused on discrete, static classifications of panic. Our paper introduces a dynamic, idiographic phenomenological system to characterize panic as it occurs across the anxiety disorders. The model consists of four grids, each with four quadrants, that focus on the degree and specificity of physiological change, catastrophic cognitions, and somatic sensations, as well as the extent and type of affect experienced. Preliminary data from an ambulatory home monitoring study are presented to demonstrate the utility of the model. A primary contribution of the model is that it increases precision and emphasizes assessment across measurement domains. The proposed system may provide the basis for future research in a number of areas, which are delineated.

This study investigated the physiological, subjective and behavioral responses to hyperventilation of four groups of Ss with: (1) clinical panic disorder (n = 13); (2) infrequent panic (n = 16); (3) no panic and high trait anxiety (n = 16); and (4) no panic and low trait anxiety. After completing a number of anxiety-related questionnaires, Ss participated in 2 min of hyperventilation during which heart rate and electrodermal activity were recorded continuously. Subjective sensations and cognitions during hyperventilation were assessed immediately following the task. After recovery, Ss could participate in a second, optional hyperventilation from which they could escape at any time. Analyses revealed no group differences in physiological responses to the hyperventilation, although group differences in subjective sensations and cognitions were found. Data are discussed with regards to the role of physiological processes vs subjective responses to anxiety-provoking stimuli in the psychopathology of clinical panic disorder.

The cornerstone of cognitive treatment (CT) for OCD is based upon the knowledge that unwanted intrusions are essentially a universal experience. As such, it is not the presence of the intrusion that is problematic but rather the associated meaning or interpretation. Treatment is flexible, depending upon the nature of the appraisals and beliefs, but can include strategies focused on inflated responsibility and overestimation of threat, importance and control of thoughts, and the need for perfectionism and certainty. The role of concealment and the relationship to personal values are important maintaining and etiological factors. The short-term and long-term treatment outcome is reviewed, along with predictors of treatment response and mechanisms of action, and the chapter concludes with future directions regarding CT for OCD.

Although exposure-based psychotherapies are an effective and widely used treatment for obsessive–compulsive disorder (OCD), the past 15 years has seen the introduction and incorporation of cognitively based models and treatments of this disorder. This chapter reviews research supporting the efficacy of exposure and response prevention (ERP) for OCD, as well as shortcomings of ERP that led to the creation of cognitive models of OCD. Outcome literature examining the efficacy of cognitively enhanced behavioral therapies in comparison to ERP will also be examined. Although treatment outcomes with ERP alone are largely equivalent to cognitively focused treatments, there may be specific presentations or settings that may be better or worse suited to the addition of cognitive elements to exposure.

Three hundred eleven female undergraduates completed the Trait form of the State-Trait Anxiety Inventory and the Panic Attack Questionnaire. One hundred thirty-nine subjects reported having experienced a panic; ten met frequency and symptom criteria for panic disorder, four reported infrequent panic with fewer than four symptoms (limited symptom panic), and the remainder ( n = 125) were classified as infrequent panickers. Fifty-eight percent of the infrequent panickers had experienced an unexpected panic. Infrequent panickers had significantly higher trait anxiety than nonpanickers and were significantly more likely to have a family member who had experienced panic. Factor analysis of panic symptoms revealed four significant factors: panic cognitions and three factors involving physiological symptoms. Factor analytic procedures may shed light on characteristics that predict the development of panic disorder.

Objective We explored the dynamic relationship between cognition and obsession severity during 2 different treatments for primary obsessions, examining evidence for the hypothesis that symptom reduction would be mediated by appraisals about the meaning of unwanted intrusive thoughts. Method Data from a recent randomized controlled trial were analyzed with traditional mediation analyses and latent difference scores. The trial had compared cognitive behavioral therapy and stress management training among 73 patients with primary obsessions. Mediation analyses were conducted with pre-, post-, and follow-up scores on the Obsessions subscale of the Yale-Brown Obsessive Compulsive Scale and 2 self-report measures of cognitions related to obsessive-compulsive disorder. Bivariate dual change score (BDCS) analyses were conducted with weekly assessments of obsession severity and appraisals of personal significance. Results Change in most cognitions related to obsessive-compulsive disorder accounted for reduction in obsession severity during the course of treatment and follow-up. BDCS analyses of the longitudinal data, however, indicated prior obsession severity is a leading indicator of subsequent change in appraisals, rather than the reverse. Analyses also suggested cognitive behavioral therapy is more effective than stress management training when symptoms are severe and that stress management training is more advantageous in the context of mild-to-moderate obsessions. Conclusions The traditional mediation analysis indicated that appraisal change is a tenable mediator of obsession reduction, but the BDCS results raise doubts about the causal direction. The results highlight the importance of examining the dynamic relationship between putative mediators and outcome variables, and they suggest interesting hypotheses about mechanisms in treatment of obsessions.

The Obsessive Belief Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III) were designed to assess beliefs and appraisals considered critical to the pathogenesis of obsessions. In previous reports we have described the construction and psychometric properties of these measures. In this study a battery of questionnaires assessing anxiety, depression, and obsessive compulsive symptoms was completed by 410 outpatients diagnosed with obsessive compulsive disorder, 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Items from 6 theoretically derived subscales of the OBQ were submitted to factor analysis. Three factors emerged reflecting (1) Responsibility and threat estimation, (2) Perfectionism and intolerance for uncertainty, and (3) Importance and control of thoughts. A 44-item version (OBQ-44) composed of high-loading items from the 3 factors showed good internal consistency and criterion-related validity in clinical and non-clinical samples. Subscales showed less overlap than original scales. Factor analysis of the III yielded a single factor, suggesting the total score be used in lieu of the 3 rationally derived subscales. The scales performed well on tests of convergent validity. Discriminant validity was promising; hierarchical regression analyses indicated that the OBQ subscales and III generally predicted OC symptoms after controlling for general distress. A revision of the OBQ, the OBQ-44, is included in the appendix.

Despite the existence of efficacious cognitive–behavioral group treatments for obsessive–compulsive disorder (OCD), no data has been presented regarding the potential impact of symptom or thematic similarity among group members. The purpose of this study was to evaluate the effect of thematic similarity among group members on outcome after cognitive–behavioral (CBT) or exposure/response prevention (ERP) treatment for OCD. Results consistently demonstrated across a range of measures no impact of thematic similarity, nor any interaction of similarity by treatment type (ERP versus CBT), on treatment outcome. These data suggest that OCD treatment groups can be formed based on consecutive client intake without negatively impacting efficacy. Depression and Anxiety 00:000–000, 2004. © 2004 Wiley-Liss, Inc.

The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.

Publisher Summary This chapter describes how cognitive–behavioral therapy (CBT) can be delivered in a group setting, the advantages and disadvantages of this treatment modality, and presents some data regarding the change in symptoms and cognition following group treatment for obsessive compulsive disorder (OCD). In cognitive behavioral approaches, exposure plays a significant role. However, the function of the exposure is not habituation to the feared stimulus, but rather a behavioral experiment to test the validity of alternate appraisals developed during treatment. Behavioral experiments are one of several tools at the disposal of the cognitive–behavioral therapist. The obsessional belief questionnaire (OBQ) and the interpretations of intrusions inventory (III) are administered during the assessment phase to identify the cognitive domains that are relevant for each patient. Cognitive challenging begins with the appraisal domain that appears to be the most common among the group members. Group treatment provides an immediate opportunity to conduct a survey regarding the importance of the appraisal process. Although all group members have OCD and thus share many similar features, the heterogeneity of their symptoms often provides the opportunity to compare and contrast appraisals.

Given the high prevalence and enormous burden of mental disorders and the efficacy of CBT in reducing symptom severity of a number of acute disorders, it is reasonable to use these same CBT strategies at an earlier stage to prevent the full expression of emotional problems. In comparison to treatment outcome research, work in prevention of mental disorders is in its infancy. Ongoing and recent prevention trials for 4 Axis I problems are introduced and the challenges of doing this work will be addressed. The goal within each one of the articles is to provide concrete guidelines and examples of the clinical work done in each trial to facilitate therapeutic efforts for individual practitioners.

The relationship between panic expectancy, social demand and agoraphobic avoidance was investigated in a group of 48 panic disorder subjects. Subjects were observed surreptitiously while completing a naturalistic behavioral avoidance task (BAT) involving either a high or low social challenge task. Subjects in the high social challenge task avoided more compared to subjects in the low social challenge task. Prediction of panic made before entering the situation and type of social challenge condition (high/low) were the only variables that accounted for significant amounts of unique variance in prediction of BAT score. The results confirm previous findings regarding the relationship between panic expectancy and avoidance and suggest that social interaction and scrutiny is a factor in avoidance.

Forty-eight females were evaluated to detect differences in panic-related symptomatology and physiological responses to 2 min of hyperventilation. Ss were divided into 3 groups: infrequent panickers; no panic/high trait anxiety; and no panic/low trait anxiety. The low trait anxiety group scored significantly lower on various self-report measures of anxiety-related symptomatology compared to Ss with infrequent panic and high trait anxiety. Hyperventilation produced no significant group differences in physiological reactivity or recovery. However, Ss with low trait anxiety reported significantly less severe sensations and a significantly lower incidence of panic during hyperventilation than the infrequent panickers and the high trait anxiety group. Ss who panicked during hyperventilation reported more intense sensations and negative cognitions than those who did not panic. Thus, Ss were distinguished by their subjective, but not their physiological responses.

An experiment was carried out on 30 spider-fearful and 30 snake-fearful subjects in an attempt to replicate the finding of a correlation between the rapid reduction of fear and the reduced likelihood of significant fear returning after an interval (low return of fear). It was also hoped to observe and closely examine the occurrence of sudden and enduring reductions in fear. The results from the two groups of fearful subjects were reassuringly similar. The fears of both groups were significantly reduced in a relatively briefsession, and small but significant returns of fear were observed after a 2 week interval, with the slow responders reporting a higher return of fear than fast responders. The time taken to reduce the fear correlated 0.36 with the return of fear. A minority of subjects did experience a subjectively important, abrupt change in their fears; these ‘glass-jar’ experiences were associated with faster (overall) reductions in fear, a lower return of fear, and subjective estimates of permanent and generalized reductions of the fear.

An experiment on the return-of-fear (ROF) was carried out on 40 snake- or spider-phobic subjects in order to determine whether an arousing event that occurs shortly before retest influences the magnitude of the ROF. Additionally, we attempted to produce a reinstatement of fear by introducing an unrelated aversive event (shock) after the fear had been reduced. The arousal manipulation successfully increased subjective arousal but not heartrate responsiveness. The increases in subjective arousal were not followed by increases in ROF, and the attempt to produce a reinstatement of fear did not succeed. A significant correlation between speed of fear-reduction and ROF was obtained.