Behavior Therapy for Obsessive–Compulsive Disorder
For individuals in the U.S. & U.S. territories
In Behavior Therapy for Obsessive–Compulsive Disorder, Dr. Samuel M. Turner demonstrates his approach to treating this form of anxiety disorder. Because this approach assumes that obsessive–compulsive disorder (OCD) derives from an underlying core fear, treatment involves exposing the client to fear-producing stimuli and teaching blocking of compulsive behaviors. The therapist takes an active role in encouraging and directing the client in efforts to prevent habitual obsessive responses to fear. In this session, Dr. Turner works with a 32-year-old woman whose obsessive–compulsive disorder takes the form of obsessive washing and avoidance behavior. Dr. Turner helps her to dismantle her fear of contamination with exercises that expose her to her core fear.
This video features a client portrayed by an actor on the basis of actual case material.
The behavioral treatment of OCD involves prolonged exposure to fear-producing stimuli and the active blocking of associated compulsive behaviors. Exposure, in this context, refers to treatment that involves confrontation with fear-producing stimuli. The various strategies used to engineer such exposure reflect different theoretical notions regarding the nature of fear reduction. The goal of exposure treatment is the elimination of maladaptive anxiety, intrusive obsessional thoughts, and associated ritualistic behaviors.
Exposure treatments can be divided along two dimensions. The first dimension pertains to whether exposure is administered in an intensive or graduated fashion. In intensive exposure, the patient is exposed directly to the stimuli he or she fears most. In gradual exposure, the patient is exposed incrementally to fear-producing stimuli, building from the least to the most feared. The second dimension pertains to whether stimuli are presented imaginally or whether they occur in vivo (in real situations). In either case, the stimuli can be presented in intensive or gradual fashion. When treating patients with OCD, the most frequently used method is intensive, although graduated methods are also used.
The form in which exposure therapy is implemented with any patient depends to a large extent on the clinical features of the patient and how the OCD is manifested in his or her life. Anxiety generated by obsessions (e.g., thoughts, images, impulses) typically instigates a strong internal drive to engage in compulsive and ritualized behavior that results in temporary anxiety relief. The compulsive behaviors are maintained because of their anxiety-reducing role.
The target of treatment for OCD is the core fear (i.e., the catastrophic fear) that underlies the obsessions and compulsion. The core fear typically differs to some extent for each OCD patient. Each session is terminated after habituation (a 50% reduction in reactivity to fear-producing stimuli) is achieved. To eliminate rituals, the therapist uses response prevention to block compulsive ritualistic behaviors (e.g., in the case of washing rituals, the patient is "prevented" from washing). This is achieved through instruction, encouragement, direction, persuasion, and a variety of other nonphysical means. Because the rituals typically serve an anxiety-reducing function, the patient must "learn" that the feared catastrophic consequences do not occur if the rituals are not performed.
Once the active treatment phase is completed, a maintenance phase involving response prevention activities can help prevent relapse. Other co-occurring conditions (such as depression, family, and work problems) may require different intervention strategies once the OCD is controlled.
Dr. Turner identifies his approach as "behavior therapy." What does this imply to you? More specifically, what do you expect of him? Will Dr. Turner be active or passive? Will the session be structured or unstructured? Directive or nondirective? Will it focus on the past or on the present? Will the session focus on behaviors, on thoughts, or on feelings? What do you expect to be the relative balance between attention to technique versus the interpersonal interaction?
Samuel M. Turner, PhD, (1944–2005) received his doctorate in clinical psychology from the University of Georgia in 1975, after completing a predoctoral internship at the University of Mississippi Medical Center. Formerly at Western Psychiatric Institute and Clinic of the University of Pittsburgh, he later served as professor of psychiatry and behavioral sciences at the Medical University of South Carolina.
Dr. Turner's career focused primarily on the anxiety disorders, and he published over 150 articles, books, and chapters on these and related topics. His books include the Handbook of Clinical Behavior Therapy (2nd ed.), Treating Obsessive-Compulsive Disorder, and Adult Psychopathology and Diagnosis (3rd ed.). He served as editor of the Journal of Psychopathology and Behavioral Assessment and The Clinical Psychologist, as associate editor of the American Psychologist, and was on the editorial board of numerous additional scientific journals.
Dr. Turner was a licensed psychologist, a diplomate of the American Board of Professional psychology in clinical and behavioral psychology, and an active clinical practitioner. In addition, he received the 1997 American Psychological Association Award for Distinguished Contribution to Professional Knowledge.
- Foa, E. B., Steketee, G. S., Grayson, J. B., Turner, R. M., & Latimer, P. R. (1984). Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects. Behavior Therapy, 15, 450–472.
- Foa, E. B., Steketee, G. S., & Oazrow, B. J. (1985). Behavior therapy with obsessive-compulsives: From theory to treatment. In M. Mavissakeliam, S. M. Turner, & L. Michelson (Eds.), Obsessive-compulsive disorder: Psychological and pharmacological treatments (pp. 49–120). New York: Plenum Press.
- Grayson, J. B., Foa, E. B., & Steketee, G. (1986). Exposure in vivo of obsessive-compulsives under distracting and attention-focusing conditions: Replication and extension. Behaviour Research and Therapy, 24, 475–479.
- Mavissakalian, M., Turner, S. M., & Michelson, L. (1985). Obsessive-compulsive disorder: Psychological and pharmacological treatments. New York: Plenum Press.
- O'Sullivan, G., & Marks, I. (1991). Follow-up studies of behavioral treatment of phobic and obsessive-compulsive neuroses. Psychiatric Annals, 21, 368–373.
- Rachman, S., & Hodgson, R. (1980). Obsessions and compulsions. Englewood Cliffs, NJ: Prentice-Hall.
- Riggs, D. S., Hiss, H., & Foa, E. B. (1992). Marital distress and the treatment of obsessive-compulsive disorder. Behavior Therapy, 23, 585–597.
- Stanley, M. A. (1992). Obsessive-compulsive disorder. In S. M. Turner, K. S. Calhoun, & H. E. Adams (Eds.), Handbook of clinical behavior therapy (2nd ed., pp. 67–85). New York: Wiley.
- Steketee, G. S. (1993). Treatment of obsessive-compulsive disorder. New York: Guilford Press.
- Turner, S. M., & Beidel, D. C. (1988). Treating obsessive-compulsive disorder. New York: Pergamon Press.
- Turner, S. M., & Stanley, M. A. (1995). Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26, 163–186.
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