Abstract
Treatment manuals have proven extremely useful in implementing exposure and ritual prevention (EX/RP) with patients with obsessive-compulsive disorder (OCD). Nevertheless, treatment manuals cannot possibly attend to all possible situations encountered in therapy, especially with OCD patients who have such a diverse range of presentations. In this article we address four commonly encountered issues not explicitly described in the widely used EX/RP treatment manuals. First, we offer suggestions on how to help patients understand their OCD symptoms in ways that fit into the theoretical framework of the treatment procedures. Second, we address how to manage excessive reassurance-seeking behavior that is often observed in patients with particularly severe symptoms. Third, we describe the importance of consistent exposure during (and after) treatment. Fourth, we discuss clinical decision-making regarding the implementation of ritual prevention.
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