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(p. 241) Commentary 

(p. 241) Commentary
Chapter:
(p. 241) Commentary
Author(s):

Deborah C. Beidel

DOI:
10.1093/med:psych/9780199733668.003.0033
Page of

date: 12 November 2019

Cassie’s treatment illustrates the very effective use of cognitive behavior therapy to treat obsessive-compulsive disorder (OCD). The authors did an excellent and thorough diagnostic assessment. Often, novice therapists initiate treatment too quickly, without a comprehensive understanding of all of the factors that may play a role in the etiology and maintenance of the disorder. For example, Cassie may have come in saying, “I am afraid of knives.” Without a thorough diagnostic assessment, a therapist may have considered this statement to represent a specific phobia and may not have probed further, thereby neglecting Cassie’s fear of losing control and hurting her family. Of course, the authors of this case were experts in the treatment of OCD and spent the time necessary to adequately understand Cassie’s clinical presentation and to design an appropriate treatment strategy. Another area of agreement was the use of cognitive behavioral treatment (CBT). As illustrated by this commentary, there are many variations in how exposure therapy may be implemented, but there is no disagreement that CBT is the treatment of choice for people with OCD. Medication may reduce general levels of arousal but is less effective in reducing symptoms of obsessions and compulsions. In the most severe cases, both CBT and medication may be necessary. Another area of agreement was the use of homework assignments, in addition to clinic treatment sessions. OCD is a complex and severe disorder, and once weekly clinic sessions will not produce the desired treatment outcome. Again, there may be differences in the specific homework activity that is selected and whether or not the therapist must accompany the patient when he or she completes initial homework assignments, but there is agreement that homework assignments are critical to positive treatment outcome....

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