Response Prevention Procedure Research Articles

Use of an Augmented Exposure and Response Prevention Procedure in the Treatment of Obsessive-Compulsive Disorder: A Case Report

This case report describes the assessment and treatment of a 21-year-old male with obsessive-compulsive disorder (OCD) using an intensive exposure and response prevention (ERP) treatment program. The patient and his father received daily 2-hour ERP sessions delivered across 10 consecutive weekdays, and monthly follow-up appointments. In addition to the condensed treatment schedule, ERP procedures were augmented to address ongoing family conflict and depressive symptoms. To the best of the our knowledge, this is the first study to include such treatment adaptations within the context of intensive ERP for an adult with OCD. Results indicated target behaviors decreased over the 2-week intensive treatment phase and were maintained during 4 months of follow-up. Ancillary outcomes reported by the patient and his father included more frequent engagement in activities of daily living and improved family communication. Outcomes of this study provide an important step toward establishing recommendations regarding ERP session frequency, especially among patients with comorbid disorders.

Case Series on Applications of EMDR to OCD

This paper is an attempt to draw a parallel between the exposure and response prevention (ERP) procedures in CBT (cognitive behaviour therapy) and the desensitisation procedures in EMDR (eye movement desensitisation processing). This paper also suggests an alternative targeting sequence that follows from the standard EMDR protocol to draw upon the strengths and application of ERP procedures in the treatment of OCD (obsessive compulsive disorder).

Enhancing extinction with response prevention via imagery-based counterconditioning: Results on conditioned avoidance and distress

Background and objectivesMaladaptive avoidance is a core characteristic of anxiety-related disorders. Its reduction is often promoted using extinction with response prevention (ExRP) procedures, but these effects are often short-lived. Research has shown that pairing a feared stimulus with a stimulus of an incompatible valence (i.e., counterconditioning) may be effective in reducing fear. This laboratory study tested whether positive imagery during ExRP (i.e., imagery counterconditioning protocol) can also reduce avoidance. MethodsIn the counterconditioning procedure, participants imagined a positive sound. There were four phases. First, participants were presented with squares on a computer screen of which one (CS+) was paired with an aversive sound and another (CS-) was not. Second, they learned to avoid the negative sound in the presence of the CS+, via a key press. Third, they were assigned to either the Counterconditioning (that was asked to imagine a positive sound during ExRP) or No Counterconditioning group (standard ExRP). Finally, they performed a test phase that consisted of two parts: in the first part, avoidance responses were available for each CS and in the second part, these responses were prevented. ResultsThe Counterconditioning intervention resulted in a short-lived reduction of distress associated with the CS+. However, groups did not differ in avoidance or distress during the test phases. LimitationsUS-expectancy ratings were collected only at the end of the experiment. ConclusionsThe results indicate that positive imagery during ExRP may be effective in reducing distress during the intervention. Explanations for the persistence of avoidance and fear are discussed.

Terapia comportamental do transtorno obsessivo-compulsivo

Behavior therapy, an experimentally-based approach, has been able to successfully treat obsessive-compulsive disorder by means of graded exposure to feared stimuli and response prevention procedures. This article will present the main treatment features, emphasizing behavioral assessment, motivational interviewing techniques, session planning guidelines, and issues on rehabilitation.

Treatment of obsessive compulsive disorder in the elderly: A review and case example

Obsessive compulsive disorder (OCD) is a prevalent form of psychopathology in the elderly, yet limited evaluation of the disorder in this age group has occurred. We review the literature and describe a case of OCD effectively treated in an 80-year-old man. Case study reports suggest that elderly persons are responsive to selective serotonin uptake inhibitors, although medication selection and dosage may need to be adjusted as a result of the medical conditions sometimes present in the elderly. Elderly persons appear able to benefit from exposure and response prevention, although behavioral intervention has not been frequently used. We describe here the first case report where exposure and response prevention procedures were successfully used and this intervention was not confounded with psychopharmacologic treatment.

Exposure and Response Prevention in the Treatment of an Okeanophobic Triathlete

An in vivo exposure and response prevention procedure consisting of seven treatment and generalization sessions was used to aid a 50-year-old woman with a lifelong fear and avoidance of swimming in the ocean. Subsequent to treatment, the subject, already a competent pool swimmer and an accomplished athlete, swam in the ocean, reduced her swim time by over 50%, and placed second in her age group while competing in a major triathlon. A 1-year follow-up indicated that she was still swimming in the ocean and participating in triathlons. The athlete/sport psychologist relationship is discussed in reference to the athlete’s compliance with treatment recommendations.

A Systematic Replication of Response Prevention to Eliminate Nocturnal Thumbsucking

A systematic replication of Van Houten and Rolider's (1984) response prevention study to eliminate nocturnal thumbsucking behavior was performed. Differences were related to the fading steps as well as the treatment duration (a shorter period), and followup (one year). A 5-year-old girl participated in this study. Response prevention procedures led to the suppression of thumbsucking behavior, which was maintained during the different fading conditions as well as during the follow-up period. Additional advantages other than the efficacy of the procedure to eliminate a chronic behavior were emphasized, such as the use of mainly positive interactions, the short duration of treatment, and the convenience for the child and her parents.

Effects of naloxone on acquisition and extinction of jump-up avoidance behavior in rats

Two experiments were carried out to assess the effects of the opioid antagonist, naloxone, on the acquisition and extinction of shock avoidance by rats in the jump-up apparatus. In Experiment 1 naloxone pretreatment facilitated acquisition but had no effect on extinction of avoidance behavior. In the second experiment the effect of naloxone on acquisition was replicated and in addition, it was shown that naloxone enhanced freezing when a response prevention or flooding procedure was introduced. Again naloxone failed to alter the course of extinction, nor did it interact with the effects of flooding which, by itself, facilitated extinction. The results suggest that naloxone's effects are limited to increasing the functional intensity of the US, and provide further support for the dissociation between extinction of avoidance behavior and other indices of fear.

Bulimia nervosa: Treatment with exposure and response prevention

Fear of weight gain, binging, and self-induced vomiting are the salient features of bulimia nervosa in normal weight individuals. An exposure plus vomiting response prevention procedure was evaluated in a multiple baseline design across three classes of food stimuli for a patient suffering from chronic bulimia nervosa. Amount of food consumed without vomiting increased and subjective discomfort after eating decreased when exposure plus response prevention treatment was sequentially applied to each class of food. Complete cessation of vomiting and binging and minimal discomfort were subsequently achieved during a postexperimental response prevention phase. Treatment effects were maintained at 10-month follow-up. The results suggest that binging in bulimia nervosa is more a consequence of vomiting than vomiting is a consequence of binging. They also support the hypothesis that vomiting in bulimia nervosa is an escape-avoidance response reinforced by anxiety reduction, similar in function to compulsive hand washing and checking rituals in obsessive-compulsive neuroses.

A behavioural approach to the treatment of obsessional rituals: an adolesent case study

In this case report Paul, a 15‐year‐old boy who displayed a number of obsessional checking rituals, was treated, using a systematic behaviour therapy package involving autogenic training, satiation and response prevention procedures. Self‐report and observations measures were used to monitor both the frequency of Paul's ritualistic behaviour and also changes in his mood state during baseline treatment and post‐treatment phases. There was a marked reduction in the frequency of checking behaviour accompanied by a more favourable assessment of mood which was maintained at a 6 month follow‐up.

Reducing Childhood Nightmares Subsequent to a Burn Trauma

This case report describes the successful treatment of a 5-year-old girl who, subsequent to an accident in which she received burns covering 30% of her body, experienced nightmares and night terrors as often as 15-20 times every night. In addition to the night terrors, she developed a strong phobic reaction to a wide range of fire-related stimuli. Treatment involved multiple stages which included a response prevention procedure, extinction, and systematic desensitization.

A case of trichotillomania in a three year old treated by response prevention

Trichotillomania (chronic hair-pulling) in a 3 yr old boy was successfully treated by his mother after she had been trained to reinforce appropriate play behaviour and ignore hair-pulling. Seventeen days had passed without recurrence of hair-pulling when the mother terminated treatment and hair-pulling returned to baseline levels. The mother refused to reinstate the initial treatment procedure but finally agreed to a response prevention procedure—trimming the child's hair—which immediately terminated hair-pulling. A six month follow-up revealed no reappearance of hair-pulling or other problem behavior. This study demonstrates the successful treatment of trichotillomania through a minimally intrusive response prevention procedure.

Effect of Response Prevention on Active and Passive Components of Avoidance Behavior

A response prevention procedure with 30 rats eliminated oneway active avoidance. However, residual fear, as indexed by passive avoidance, was maintained following response prevention.

The effect of a conditioned fear inhibitor (CS-) during response prevention upon extinction of an avoidance response

Pairing a Pavlovian safety signal ( CS—) with a response prevention period was contrasted with other response prevention procedures to determine relative effectiveness for the elimination of learned avoidance behavior. After acquiring a one-way avoidance response, five groups of ten rats received various blocking or control treatments and were then compared on extinction performance. The four blocking treatments included blocking paired with a safety signal; blocking only; blocking paired with a novel stimulus; and blocking paired with a preexposed noncontingent tone. The fifth group served as a handling control. Compared to the handling control, all four blocking groups reached extinction criterion in fewer trials. Further, the safety signal group extinguished faster than the blocking only group or the blocking with noncontingent tone group. Results were viewed as an indication of the potential efficacy of pairing-conditioned fear-inhibiting cues with response prevention procedures for the elimination of fear-motivated behavior. Implications for behavioral therapy techniques were discussed.

Persistence of response prevention effects following retraining of escape behavior

This study evaluated the effects of response prevention procedures on the extinction of escape behavior following the reinstatement of shock-escape training prior to the start of extinction. Female hooded rats were assigned to four groups ( N = 10) in a factorial design which orthogonally combined response prevention or pseudo-prevention procedures with escape retraining or no retraining procedures. Results showed that prevention reliably impaired shock-escape behavior on early retraining trials; but this effect dissipated completely by the end of retraining. In extinction, prevention reliably facilitated the extinction of escape behavior relative to that of pseudo-prevention controls; but the degree of facilitation was reliably attenuated by retraining procedures. These findings were related to the competing response interpretation of prevention effects.

Effects of progesterone and nesting materials on response prevention and extinction of avoidance in rats

Female rats received either progesterone or saline injections prior to learning a simple one-way avoidance response. During a 10-min response prevention procedure half of the animals in each group had nesting material present while the remaining rats did not. The availability of nesting material during response prevention hastened extinction while progesterone injections significantly increased the frequency of nesting activities during response prevention but did not affect rate of extinction. The availability of nesting materials increased the frequency of standing but reduced the frequency of crouching. The results were discussed in terms of the role of ethological displacement activities during response prevention as well as the role of ‘relaxational’ activities as discussed by Baum and Denny.

Effects of response prevention upon the “Kamin effect” in rats

After rats had incompletely learned a shuttle escape-avoidance task, response prevention procedures were introduced and animals were retested on the avoidance task after 0, 1, or 24 h. Female control animals, which did not receive response prevention, showed the U-shaped retention function characteristic of the “Kamin effect,” while response prevention disrupted avoidance performance under every condition. Male rats exhibited a much smaller effect with minimal recovery after 24 h. Results were discussed in terms of potential methodological and theoretical significance for the problem of residual fear.

Effects of progesterone and nesting materials on response prevention and extinction of avoidance in ovariectomized female rats

Ovariectomized female rats received either progesterone or oil injections prior to learning a simple one-way avoidance response. During a 10-min response prevention procedure, half of the animals in each group had nesting materials present, while the remaining rats did not. The availability of nesting material during response prevention hastened extinction independent of progesterone injections.

Elimination of an infant's crying through response prevention.

After traditional methods had failed, a response prevention procedure was used to eliminate crying (at 4 a.m.) in a 19-wk.-old infant. The procedure involved initially attempting to extinguish awakening and crying by ignoring the crying of S; this was followed by continued extinction plus preventing S from rolling over (which prevented a sequence of behaviors leading to crying). Response prevention facilitated the elimination of crying.

Effects of temporal placement of response prevention on extinction of avoidance in rats

Two experiments investigated the effects of prior extinction trials upon the effectiveness of response prevention procedures (flooding) in facilitating extinction of avoidance in rats. The results showed that both prior CS only extinction trials and response prevention independently hastened extinction and that response prevention is enhanced if prior extinction has already taken place. The results were interpreted as being consistent with a relaxation interpretation of extinction of avoidance behavior providing a ‘distraction’ or ‘attention shift’ factor is incorporated into theory.