Strategies for Optimizing Traditional Exposure and Response Prevention: A Case Study Example in an Adolescent With Contamination-Based OCD

Abstract

Cognitive Behavioral Therapy (CBT) with an emphasis on Exposure and Response Prevention (ERP) has consistently been observed to be an efficacious treatment for obsessive-compulsive disorder (OCD). Although ERP is currently considered the gold-standard, first-line psychological treatment, individuals with chronic fluctuations in symptom presentations or especially severe cases may require additional supplements to exposure that maximize learning and facilitate greater generalization of learning experiences. The present case study serves as an example of how traditional aspects of exposure-based CBT (e.g., psychoeducation, hierarchy building, functional analysis, homework) can be successfully used in addition to leveraging more contemporary stylistic modifications (e.g., explicit expectancy violation, context variability) that may optimize treatment in complex or difficult cases. In the present case study of a patient with contamination-based OCD, functional impairment and disorder symptoms responded to treatment and remained improved at a 3-month follow-up. Implications of the case study are discussed and recommendations are offered for clinicians treating complex or challenging OCD cases.