Individual, Group, and Multifamily Cognitive-Behavioral Treatments

Abstract

F O C U S I N F L U E N T I A L P U B L I C A T I O N S Since the early 1980s, the psychosocial treatment of choice for obsessive-compulsive disorder (OCD) has been exposure for obsessions and prevention of rituals, or “response prevention,” for compulsions conducted mainly in an individual format. This treatment method, based on clinical observations that obsessions increase anxiety and compulsions reduce it, has now been incorporated into the diagnostic criteria for OCD. That is, obsessions “cause marked anxiety or distress” and compulsions “are aimed at preventing or reducing distress” provoked by obsessions (American Psychiatric Association 1994). Not surprisingly, behavioral treatment based on this model includes procedures to reduce anxiety associated with obsessions and to prevent or curtail ritualistic behavior. In this chapter we briefly describe the theoretical model for exposure and response prevention (ERP) and then review the empirical literature supporting the efficacy of this method. In addition, cognitive conceptualizations and interventions have gained considerable recent attention and the limited literature on this method will also be reviewed. Promising alternative treatment strategies to deliver ERP, group, and multifamily formats offer added advantages that may be particularly beneficial to some patients, so we present literature relevant to group and multifamily behavioral treatment as well. BEHAVIORAL MODELS