Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of "Daniel"

Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.

The Unified Protocol for Anxiety Disorders

Of any cluster of illnesses outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), none is more prevalent, likely to serve as a comorbid diagnosis, or costly in the United States than anxiety disorders. This chapter outlines the applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for the treatment of such disorders. First, we briefly review the background research that provides context for the use of transdiagnostic treatment for anxiety disorders. The UP, with its intent to target comorbidity, is an approach that can be especially helpful for therapists who want to use an evidence-based treatment, prefer the structure of a manualized protocol, and value the benefits that a workbook can bring to patients. We then present two clinical case studies to demonstrate how each individual module of the UP maps onto typical cases of principal and comorbid anxiety. Recommendations for specific methods of protocol implementation are also described.