A 28-year-old, married, Caucasian female with obsessive-compulsive disorder was referred for home-based cognitive-behavioral therapy. At the time of intake, she obtained a severe rating on the Yale-Brown Obsessive-Compulsive Scale, and was considered chronic and treatment refractory after failing previous trials of behavior therapy and pharmacotherapy. Prior treatment attempts in traditional settings were unsuccessful because she failed to generalize gains beyond such settings. She was evaluated at baseline, after treatment, and again at an 18-month follow-up. Performing endstate functioning and reliable change assessment as described by Jacobson andTruax, the authors found that the patient realized clinically significant gains after treatment, and that she maintained those gains at follow-up. This illustrates that severe, chronic, and refractory patients may benefit by receiving cognitive-behavioral therapy as a home-based intervention. The need for replication, further controlled trials, and the implications this case may have upon future research are discussed.
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