19.
Obsessive-compulsive disorder (OCD) was considered until the mid-1960s to be resistant to treatment with both psychodynamic psychotherapy and medication. The first significant breakthrough came in the form of exposure and ritual prevention. This, along with other forms of cognitive Endocrinology antagonist behavioral therapy (CBT), and earlier behavioral therapy,

will be discussed below. Cognitive behavioral conceptualization of OCD Several cognitive behavioral theories about the development and maintenance of OCD symptoms Inhibitors,research,lifescience,medical have been put forward. Dollard and Miller1 adopted Mowrer’s twostage theory2,3 to explain the development and maintenance of fear/anxiety and avoidance in OCD. Mowrer’s theory maintains that a neutral event stimulus (conditioned stimulus, CS) comes to elicit fear when it is repeatedly presented together with an event that by its nature Inhibitors,research,lifescience,medical causes pain/distress (unconditioned stimulus; UCS). The CS can be a mental event, such as a thought, and/or a physical object, such as a bathroom or trash cans. After fear/anxiety/distress

to the CS is acquired, escape or avoidance behaviors are developed to reduce the anxiety. In OCD, the behavioral avoidance and escape take the form of repeated compulsions or rituals. Like other avoidance behaviors, compulsions are maintained because they indeed reduce the distress. Not only does Mowrer’s Inhibitors,research,lifescience,medical theory adequately explain fear acquisition,4 it is also consistent with observations of how rituals are Inhibitors,research,lifescience,medical maintained. In a series of experiments, Rachman and colleagues demonstrated that obsessions increase obsessional distress and compulsions reduce this distress.5,6 This conceptualization of a functional relationship between obsessions and compulsions influenced the definitions of OCD in DSM-III 7 and its successors. Foa and Kozak8 proposed that OCD is characterized by erroneous cognitions. First, OCD sufferers assign

a high probability of danger to situations that are relatively safe. For example, an individual with OCD will Inhibitors,research,lifescience,medical believe that if he or she touches a public doorknob without washing his or her hands thoroughly, the germs on the doorknob will cause serious disease to him or her and/or to people whom he or she touched with dirty hands. Second, individuals with OCD exaggerate the severity of the bad things that they think can happen. For example, contracting a minor cold is viewed as a terrible thing. Foa and Kozak also pointed out that individuals either with OCD conclude that in the face of lack of evidence that a situation or an object is safe, it is dangerous, and therefore OCD sufferers require constant evidence of safety. For example, in order to feel safe, an OCD sufferer requires a guarantee that the dishes in a given restaurant are extremely clean before eating in this restaurant. People without OCD, on the other hand, conclude that if they do not have evidence that a situation is dangerous, then it is safe.