Cognitive therapy in the treatment of obsessive—compulsive disorder

Behaviour therapy, namely exposure and response prevention, has for many years been the treatment of choice for most patients with obsessive—compulsive disorder (OCD). However, at least 25% of patients with OCD refuse exposure and response prevention or drop-out early. Of those who do comply, about 75% make reasonable gains and maintain them in the long-term. This means that 50% of patients who are offered treatment by exposure and response prevention either refuse, drop-out or show little improvement. Many patients find exposure distressing and this is probably the main reason for dropping-out early. Treatment failures tend to be associated with a depressed mood, over-valued ideation, slowness, mental compulsions and severe degrees of avoidance.