Obsessive-compulsive disorder has typically been seen as a treatment-resistant mental disorder. Neither behavioral therapy nor psychodynamic psychotherapy nor psychotropic medication had shown any promise in the 1960s. That is, not until the advent of exposure and ritual prevention therapy. This form of therapy is closely related to cognitive behavioral therapy. Throughout this article series, cognitive behavioral therapy will be abbreviated CBT and exposure and ritual or response prevention will be abbreviated EX/RP. It is these forms of therapy which have shown the most promise in treating OCD.
Various hypotheses have been put forward in order to explain the nature of OCD symptoms. Some researchers adopted a two-stage theory in which a neutral stimulus (conditioned stimulus) elicits fear when repeatedly presented with an event which produces pain or distress (unconditioned stimulus). The conditioned stimulus can be anything fro a mental event or an object. The conditioned stimulus anxiety is thus an acquired anxiety, and OCD is the manifestation of the behavioral avoidance whose purpose is to escape the unpleasant anxiety. It is by means of compulsions that these obsessive anxieties are kept at bay. Obsessions increase distress and compulsions decrease them.
One of the reasons CBT is believed to be effective for OCD is because OCD results from errant cognitions. Those with OCD attribute a great deal of danger to harmless situations. For example, someone with OCD may believe that touching a doorknob entails a high degree of probability of becoming deathly ill. They also overestimate the severity of things that can go wrong.
One researcher offered a comprehensively cognitive account of OCD. He said that those with the disorder believe that one ought to exercise control over one’s own thoughts, that a thought about harming someone is the same as intending to, that extenuating circumstances can never diminish responsibility for harm, that thinking about an action is the same as doing it, and that failing to prevent harm is the same as causing it.
Psychoanalytic and psychodynamic therapies have typically not worked well. Those who adhere to this theoretical framework thus unsurprisingly regard it as intractable. Behavioral interventions have met with mixed results. They aimed to decrease obsessional anxiety by exposing patients to these events until patients became adapted or habituated to them. This is similar to the notion of systematic desensitization as applied to phobias. Unfortunately, this approach has not had much success.