This case study describes the use of intensive exposure and response prevention (ERP) for the treatment of pediatric obsessive-compulsive disorder (OCD). The adolescent described in this report lives a long distance from treatment providers with expertise in managing severe OCD symptoms. Thus, he has to travel out of town for effective therapy. The treatment program results in substantial immediate benefits. However, gradual relapse is noted once treatment is over and the patient returns to his home environment. Obstacles to the accessibility of ERP for pediatric OCD, conducting successful treatment, and generalizing and maintaining gains are discussed with the aim of drawing attention to, and facilitating the prevention of, these difficulties. Suggestions for addressing the shortcomings highlighted by this case are presented.
Abramowitz, J. S. (1998). Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance. Behavior Therapy, 29, 339-355.
2.
Abramowitz, J. S., Franklin, M. E., & Cahill, S. P. (2003). Approaches to common obstacles in the exposure-based treatment of obsessive-compulsive disorder. Cognitive & Behavioral Practice, 10(1), 14-22.
3.
Abramowitz, J. S., Whiteside, S. P., & Deacon, B. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36, 55-63.
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
5.
Antony, M. M., Downie, F., & Swinson, R. P. (1998). Diagnostic issues and epidemiology in obsessive-compulsive disorder. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds.), Obsessive-complusive disorder: Theory, research, and treatment (pp. 3-32). New York: Guilford.
6.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Oxford, UK: International Universities Press.
7.
Eich, E. (1995). Mood as a mediator of place dependent memory. Journal of Experimental Psychology: General, 124(3), 293-308.
8.
Emmelkamp, P., & Foa, E. B. (1983). Failures are a challenge. In E. B. Foa & P. Emmelkamp (Eds.), Failures in behavior therapy (pp. 1-9). New York: John Wiley.
9.
Foa, E. B., & Emmelkamp, P. (Eds.). (1983). Failures in behavior therapy. New York: John Wiley.
10.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
11.
Frances, A., Docherty, J. P., & Kahn, D. A. (1997). Treatment of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 58, 5-72.
12.
Franklin, M. E., Kozak, M. J., Cashman, L. A., Coles, M. E., Rheingold, A. A., & Foa, E. B. (1998). Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: An open clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 412-419.
13.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., et al. (1989). The Yale-Brown Obsessive Compulsive Scale: II. Validity. Archives of General Psychiatry, 46, 1012-1016.
14.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleishmann, R. L., Hill, C., L., et al. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
15.
Hiss, H., Foa, E. B., & Kozak, M. J. (1994). Relapse prevention program for treatment of obsessive-compulsive disorder. Journal of Consulting & Clinical Psychology, 62(4), 801-808.
16.
Kovacs, M. (1992). Children’s Depression Inventory: Manual. North Towanda, NY: Multi-Health Systems.
17.
March, J., & Leonard, H. L. (1996). Obsessive-compulsive disorder in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1265-1273.
18.
March, J., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York: Guilford.
19.
March, J. S. (1995). Cognitive-behavioral psychotherapy for children and adolescents with OCD: A review and recommendations for treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 7-18.
20.
Muris, P., Merckelbach, H., Ollendick, T., King, N., & Bogie, N. (2002). Three traditional and three new childhood anxiety questionnaires: Their reliability and validity in a normal adolescent sample. Behaviour Research & Therapy, 40, 753-772.
21.
Muris, P., Schmidt, H., & Merckelbach, H. (2000). Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: The Screen for Child Anxiety Related Emotional Disorders and the Spence Children’s Anxiety Scale. Personality & Individual Differences, 28, 333-346.
22.
Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research & Therapy, 42, 813-839.
23.
Pauls, D. L., Alsobrook, J. P., Goodman, W., Rasmussen, S., & Leckman, J. F. (1995). A family study of obsessive-compulsive disorder. American Journal of Psychiatry, 152, 76-84.
24.
Pediatric OCD Treatment Study Team. (2004). Cognitive-behavior therapy, Sertraline, and their combination for children and adolescents with Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association, 292(16), 1969-1976.
25.
Rachman, S. (1979). The return of fear. Behaviour Research & Therapy, 17(2), 164-166.
26.
Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research & Therapy, 16, 233-238.
27.
Rowe, M. K., & Craske, M. G. (1998). Effects of an expanding-spaced vs. massed exposure schedule on fear reduction and return of fear. Behaviour Research & Therapy, 36(7/8), 701-717.
28.
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research & Therapy, 37, S29-S52.
29.
Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W., et al. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 844-852.
30.
Schmidt, R. A., & Bjork, R. A. (1992). New conceptualizations of practice: Common principles in three paradigms suggest new concepts for training. Psychological Science, 3(4), 207-217.
31.
Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10, 231-237.
32.
Sheehan, D. V. (1986). The anxiety disease. New York:Bantam Books.
33.
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research & Therapy, 36, 545-566.
34.
Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., & Foa, E. B. (2003). Intolerance of uncertainty in obsessive-compulsive disorder. Journal of Anxiety Disorders, 17, 233-242.
35.
Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality & Social Psychology, 53, 5-13.
