Response Prevention Therapy Research Articles

ACT-Informed Treatment of Co-morbid Psychiatric Disorders in the Postpartum Period: A Case Report

The literature describing psychological interventions for co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) is limited. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that targets functionally avoidant behavior underlying both OCD and PTSD. The current case report describes how an ACT-informed approach to treatment was implemented over 14 sessions to treat co-occurring OCD and PTSD in a 9-months postpartum adult woman. The patient was initially referred to psychotherapy by her psychiatrist and showed high motivation to engage in treatment. This case presentation outlines how the intervention targeted core ACT processes while also incorporating components from both exposure and response prevention (ERP) and cognitive processing therapy (CPT) to address the patient’s presenting concerns. Measurements of OCD and PTSD symptom severity, as well as of depressive and anxiety symptoms, over the course of treatment are included. Health-related comorbidities, psychiatric medications, and implications are discussed.

Identifying Trajectories of Symptom Change in Adults with Obsessive Compulsive Disorder Receiving Exposure and Response Prevention Therapy

Identifying Trajectories of Symptom Change in Adults with Obsessive Compulsive Disorder Receiving Exposure and Response Prevention Therapy

A brief course of digitally delivered cognitive behavioural therapy for the treatment of blood contamination-based obsessive-compulsive disorder: a structured case report

Abstract The lifetime prevalence of OCD in the UK is estimated to be between 1 in 100 and 1 in every 50 people. It is therefore necessary to explore innovations in practice to expand the reach of the gold standard therapeutic approaches of exposure with response prevention (ERP) and cognitive behavioural therapy (CBT). The COVID-19 pandemic has facilitated such innovations with several services accommodating changes to routine practice by utilising digital platforms to provide videoconference-delivered therapy. Despite a growing evidence base demonstrating efficacy and scope for the use of videoconference-delivered CBT for obsessive-compulsive disorder (OCD), there remains qualitative research collated from clinicians which suggests that a lack of practitioner confidence and a low belief in positive outcomes are barriers to adopting remote therapy practices for clinicians. Therefore, this structured case report describes the assessment, formulation, intervention and outcome of an 11-week videoconference-delivered therapeutic intervention. Reflections are made regarding the use of the digital platform throughout the intervention, alongside the strengths and difficulties of applying videoconference-delivered CBT for OCD. Key learning aims (1) To illustrate a digital treatment of OCD through flexible application of the current evidence base. (2) To gain an understanding of the strengths and weaknesses of delivering digital out-patient CBT for OCD. (3) To consider the utility of structured case reports in routine practice when delivering digital therapy.

The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder.

Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients' ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.

1 Neurosurgery for severe OCD: the past, present and future

Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.

Who would like a monster like me to be alive? Obsessive compulsive disorder or pedophilia in a patient with high functioning autism spectrum disorder

IntroductionCase of a 17yo patient with high functioning ASD and OCD with obsessions about being a pedophile, with suicidal ideation and self-harming behaviors. He was followed in outpatient care for one year since his first contact with Mental Health, following an inpatient admission for suicidal ideation.ObjectivesDifferential diagnosis between OCD, ASD and possible pedophilia. Learn about different levels of care involved, and other possibilities. Therapy resources used.MethodsDescription of the case report: description of initial and final Mental Status Exam Differential Diagnosis: ASD vs OCD vs Pedophilia vs Depressive Disorder Children’s Yale-Brown Obsessive Compulsive Scale Therapy: family based therapy, and Exposure response prevention therapy.ResultsIntrusive images, and reassurance seeking, helped with OCD diagnosis. ASD made symptoms harder to manage with SSRIs alone, which drove to add Aripiprazol at low doses in outpatient care. CY-BOCS showed obsessions other than doubts about being a pedophile. He participated in Exposure response prevention therapy with response, especially when antipsychotic medication was added. Family based therapy worked with his parents in not providing excessive reassurance, and with the patient in gaining insight about his OCD. Decreased anxiety, decreased self-deprecation and no new suicidal thoughts Functionality of the patient in the community improved, with possibility of going college next year.Conclusions Recommendation of good assessment of sexuality in ASD population Importance of individual and family therapy for OCD and specially when there is poor judgement and insight in the patient. Importance of combined treatment: pharmacology + therapyConflict of interestAlicia Koplowitz Foundation

Variations on Exposure Therapy: Best Practices for Managing Public Speaking Anxiety in the Online Communication Classroom

Exposure and response prevention (ERP) therapy techniques offer unique opportunities for comprehensive management of public speaking anxiety in the online public speaking classroom beyond exposure to only the speech-giving act itself. This best practices article outlines nontraditional strategies for incorporating ERP practices in a distance-learning setting.

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.

Comparing the Effect of Exposure and Response Prevention and Paradoxical Time Table Therapy Techniques on the Obsessive-Compulsive Disorder Patients

Aims: Obsessive-Compulsive Disorder (OCD) is one of the most common psychiatric disorders. Almost about five million Americans are identified with OCD every year. The purpose of this study was to compare the effectiveness of the Exposure and Response Prevention (ERP) and paradoxical time table therapy technique on OCD patients. Methods & Materials: This experimental study was an extension of the multi-group pre-test post-test design. The statistical population of the study consisted of all OCD patients referred to private clinics and psychotherapy centers in Tehran in 2018, of whom 45 cases were selected through available sampling randomly assigned to three groups of 15. Patients in the first group received ERP (8 sessions) and patients in the second group received a paradoxical time table technique (4 sessions) individually. In the present study, the Maudsley Obsessive-Compulsive Inventory (1997) was used. The data were analyzed using Analysis of Covariance (ANCOVA) using SPSS software. Findings: The results showed the significant effectiveness of ERP and the paradoxical time table technique on the reduction of OCD (P<0.001). Conclusion: Paradoxical time table therapy, as an alternative treatment of response prevention technique, can eliminate maladaptive thinking strategies about anxiety as well as uncompromising threat monitoring in OCD patients.

Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment

The coronavirus disease 2019 (COVID-19) pandemic sparked significant anxiety regarding viral rates and means of transmission. Heightened concerns about contamination have prompted new hygienic strategies to vigilantly guard against infection, including hand washing immediately after touching foreign objects or suspected contaminants. This has presented a critical challenge for the delivery of exposure and response prevention (ERP) therapy to individuals with contamination fears due to Obsessive Compulsive Disorder (OCD), as providers must manage not only their clients’ attitudes and reactions but their own as well. In this investigation, self-identified anxiety and OCD treatment specialists (N = 139) provided demographic information, including their anxiety and OCD caseloads, and completed measures related to intolerance of uncertainty (IUS-SF; Carlton et al., 2007), beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The Chills; Maruskin et al., 2012). We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure. The Chills Scale was used to assess BIS activation, a broad assessment of vasoconstriction responses associated with different emotional reactions, and includes a subscale (coldness) that evaluates vasoconstriction associated with defense against pathogens. Both coldness and OCD caseload, but not anxiety caseload or subscales of intolerance of uncertainty, emerged as significant predictors of clinicians’ beliefs about exposure; increases in OCD caseload were also related to decreases in negative beliefs about exposure. Findings are useful in determining methods for aiding clinicians in developing effective approaches to contamination fears during and post-pandemic that include addressing their own BIS-related concerns and mapping out means for social behavioral norms associated with engaging in exposure treatment.

Children with neurodegenerative disease and obsessive-compulsive behaviour.

Children with neurodegenerative diseases progressively lose skills and develop somatic and psychiatric symptoms. Obsessive-compulsive disorder (OCD) may occur, a disorder for which effective medical and psychological treatments are available. However, whether these treatments are useful for children with neurodegenerative disease is unknown. A child with an uncommon form of neurodegenerative disease (with loss of sight and incipient cognitive decline) had during the previous year developed time-consuming compulsive behaviours. The child spent much of the day at home (> 8 hours), turning on/off switches, opening/closing doors, repeating after others and so on. A diagnostic assessment concluded that the child fulfilled the criteria for OCD, with predominantly compulsive acts. The child began combined treatment with sertraline and exposure and response prevention therapy (ERP). It was necessary to adapt the ERP to the neurodegenerative disease, with strong parental involvement. After six months the compulsive acts were gone. Children with neurodegenerative disease may have a high risk of psychiatric disorders, but the literature is sparse on phenomenology and treatments. The present case study documents that OCD can occur in a child with neurodegenerative disease and that the combined medical and psychological treatments were effective.

The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap.

This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.

Distressed Lonely Siblings’ Struggle with Obsessive Compulsive Disorder

Background: Obsessive Compulsive Disorder (OCD) is a common and often disabling, psychiatric disorder Earlier it was considered a difficult-to-treat disorder these viewpoints are radically changed in the last three decades as cognitive behavioural therapy (exposure and response prevention therapy), has shown significant results for individuals suffering from OCD. In the present report, two cases of Obsessive Compulsive Disorder (OCD), which happened to be siblings (one male one female) are being reported. In contrast to most other case reports depicted in world literature, the two siblings reported here were living under a roof but couldn’t talk for years. Both felt that their relationship suffered badly through their illness; as both of them were having a distressing sexual obsession of each other, along with other compulsions. The case report illustrated the journey of two distressed and lonely siblings’ struggle with OCD. Assessment & Management: OCD was diagnosed applying the existing criteria for OCD in the tenth revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10), in addition, Y-BOCS also used to determine the severity of symptoms, pre-treatment and improvement Post-treatment. Therapy was adapted component from cognitive behaviour therapy & Exposure and Response Prevention and typically involves 16 to 20 sessions. Outcome: This case report shows that Psychological intervention led to significant symptomatic improvement in the patients discussed. By present findings and understanding of the cases, it is to claim for sure that for successful treatment of OCD psychological treatment must be used. Keywords: Obsessive compulsive disorder, sexual thoughts, exposure and response prevention

Chinese Therapists' Beliefs About Exposure Therapy for Anxiety and Obsessive-Compulsive Disorders.

The goal of this study was to assess Chinese therapists' beliefs about exposure therapy and to examine the psychometric properties of the Chinese version of the Therapist Beliefs about Exposure Scale (TBES). Modification of therapists' beliefs about exposure therapy was also assessed following attendance at an exposure and response prevention therapy (ERP) training workshop. A total of 203 therapists participated in the study. The TBES and a measure of anxiety sensitivity were administered in Chinese. After a half-day ERP training workshop, the Chinese version of the TBES was administered to the participants again. The Chinese version of the TBES demonstrated adequate internal consistency, moderate item-level psychometric properties, and a normal distribution in the sample in this study. The TBES scores of the participants decreased significantly after they attended an ERP training course. The reduction in TBES scores was significantly correlated with therapists' caseload of clients with obsessive-compulsive disorder. The results of this study support the reliability of the Chinese version of the TBES. Chinese therapists had more negative beliefs about exposure than did American therapists who were evaluated in a different study; however, therapists' negative beliefs were significantly reduced after they attended an ERP training workshop. Future studies are encouraged to explore effective strategies to improve the disseminiation and delivery of exposure therapy in China.

Clinical Aspects of Premonitory Urges in Patients with Tourette's Disorder.

Most patients with Tourette’s disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

9.4 OCD Camp: Combining Exposure and Response Prevention and Adventure Therapy for Youth and Young Adults With OCD

Exposure and response prevention (ERP) is the gold-standard psychotherapy for OCD and has been found to be highly effective across numerous treatment trials for youth and adolescents. However, not all patients benefit from ERP for a variety of reasons (ie, treatment refusal, treatment dropout, low motivation). Thus, there is a need to identify novel ways to augment and enhance existing evidence-based treatments for OCD for some patients. Adventure therapy (AT) has been applied and studied in youth with a wide range of mental health concerns. Several aspects of AT are a natural fit for treating anxiety-related problems, including that this approach cultivates an environment of healthy risk taking and challenge by choice, both of which are consistent with principles of exposure therapy. Additionally, the group-based model of AT programs can help to increase social support and normalization of symptoms, as well as decrease shame and stigma about mental health problems. Finally, such programs offer an opportunity for youth to work on symptoms in a novel and more “typical” context, outside of a provider’s office or hospital setting.

Investigation of a Mobile "Serious Game" in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study.

Exposure and response prevention (ERP) therapy is considered a first-line treatment for obsessive-compulsive disorder (OCD). Dysregulation in the cortico-striato-thalamo-cortical (CSTC) circuit has been implicated in the pathophysiology of OCD, as have decreased functional connectivity (FC) between the dorsal anterior cingulate cortex (dACC) and the prefrontal cortex and increased FC between the dACC and the basal ganglia. We hypothesized that a new ERP-inspired mobile "serious game" would improve clinical symptoms in OCD and that symptom improvement would be associated with altered FC within CSTC. Fifteen OCD subjects and 15 healthy controls were recruited. All subjects completed questionnaires covering demographic data, the Yale-Brown Obsessive-Compulsive Scale, the Beck Depressive Inventory, and the Beck Anxiety Inventory. In addition, all subjects were scanned at baseline to assess brain FC using resting-state functional magnetic resonance imaging. After 3 weeks of gameplay, FC from the left dACC seed to the right frontal precentral gyrus and from the right dACC seed to the left inferior frontal gyrus and the right middle frontal gyrus, increased in the OCD group. Responders showed increased brain connectivity from the left dACC seed to the right superior frontal gyrus compared with nonresponders. Our results suggest that serious games may improve symptoms in OCD and that this improvement may be related to increased brain connectivity between the dACC and the prefrontal cortex. Further exploration is needed to assess the potential role of serious games in OCD treatment.

ENHANCING COGNITIVE-BEHAVIORAL THERAPY FOR OBSESSIVE-COMPULSIVE DISORDER WITH TRANSCRANIC MAGNETIC STIMULATION: A PROOF OF CONCEPT

Cognitive behavioral therapy (CBT) is a well established first line treatment for obsessive compulsive disorder (OCD). It consists of a cognitive and a behavioral treatment (exposure and response prevention therapy (ERP)) [1]. The goal of the cognitive treatment is the cognitive restructuring of meta-cognitions while the goal of exposure therapy is enhancing and facilitating patients’ fear extinction processes in front of the feared object, situation or thought/obsession. Several studies have tried to enhance fear extinction through pharmacological agents with mixed results [2]. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS), through its capacity to induce long-term potentiation, is able to modulate learning processes and hippocampal plasticity [3]. Moreover, several studies showed that HF-rTMS over the dosrsolateral prefrontal cortex (DLPFC) is able to induce better working memory performance after active stimulation [4]. Thus, rTMS could represent a promising tool to enhance cognitive restructuring and fear extinction learning processes during the cognitive-behavioral treatment sessions. Recently, we published a case report of a patient treated with HF-rTMS over the left DLPFC before each ERP session [5]. Here we adopted a new protocol in order to potentiate both the cognitive and the behavioral part of the treatment. The aim of this study was to evaluate the potential CBT enhancing effect of HF-rTMS over the left DLPFC in OCD patients who failed to respond to a previous CBT trial. Each patient underwent a 16 sessions CBT trial (1 session per week, 50/60 minutes per session). The first six sessions were dedicated to establishing an individual hierarchy of obsessions and compulsions and to a cognitive restructuring of meta-cognitions. The following 10 sessions focused on in vivo ERP exercises. For the first six sessions patients underwent a HF-rTMS session over the left DLPFC immediately before the session in order to enhance working memory processes during cognitive restructuring of metacognitions (6 stimulation sessions). Subsequently, each exposure session was immediately followed by an HF-rTMS session over the left DLPFC (10 stimulation sessions). During the treatment, 32 trains of 5 seconds has been applied at 10 Hz and at 110% of the left motor trheshold over the left DLPFC, with a 25 seconds inter-train interval (a total of 1600 stimuli per session). No pharmacological treatment changes were allowed during the CBT trail and patients were stable on their undergoing medications since 4 weeks before starting the CBT sessions. We enrolled two OCD patients (with prominent checking and symmetry/ordering symptoms respectively) who failed a previous CBT trial and showed only slight depressive symptoms. At the end of the 16 CBT sessions patients showed a 35% and 30% symptoms reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) respectively. HF-rTMS was well tolerated. rTMS could represent e tolerable tool in order to enhance the effect of CBT with exposure and response prevention techniques in patients with obsessive-compulsive disorder.

Obsessive-Compulsive Disorder in Children and Adolescents.

Obsessive-compulsive disorder (OCD) can be a disabling condition for children, adolescents, and their families. The majority of children and adolescents with OCD have poor academic functioning and a comorbid diagnosis. Many patients will respond with exposure and response prevention therapy. However, for those who are unable, unwilling, or do not fully respond to conservative treatment, it is essential that advanced practice nurses are able to appropriately evaluate and prescribe for OCD in their young patients. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 15-18.].