Obsessive-compulsive disorder (OCD) frequently co-occurs during a major depressive episode (i.e., Major depressive disorder, MDD). Concurrent depressive episodes may present additional challenges and barriers in OCD treatment; therefore, clinicians should address both symptom domains simultaneously. The present case study illustrates an example of an individual presenting with OCD symptoms falling under aggressive and sexual domains. The treatment utilized was exposure and response prevention (ERP), which is empirically supported to address OCD symptoms. Additional treatment elements, such as behavioral activation, building self-concept through mastery, and emotional processing were incorporated to specifically address depression symptoms, which enhanced the efficacy of ERP. The current case presentation provides evidence that the utilized combination of treatment modalities is feasible to implement and may effectively reduce OCD symptoms during a depressive episode.
AbramowitzJ. S. (2004). Treatment of obsessive-compulsive disorder in patients who have comorbid major depression. Journal of Clinical Psychology, 60, 1133-1141. doi:10.1002/jclp.20078
2.
AbramowitzJ. S.FoaE. B. (2000). Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD?Behavior Therapy, 31, 795-800. doi:10.1016/S0005-7894(00)80045-3
3.
AbramowitzJ. S.FranklinM. E.SchwartzS. A.FurrJ. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71, 1049-1057.
4.
AbramowitzJ. S.StorchE. A.KeeleyM.CordellE. (2007). Obsessive-compulsive disorder with comorbid major depression: What is the role of cognitive factors?Behaviour Research and Therapy, 45, 2257-2267. doi:10.1016/j.brat.2007.04.003
5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
6.
BeckA. T.SteerR. A.BrownG. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
7.
CuijpersP.SijbrandijM.KooleS. L.AnderssonG.BeekmanA. T.ReynoldsC. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13, 56-67. doi:10.1002/wps.20089
8.
Dingman BogerK.LuiselliJ. K. (2010). Treatment of co-occurring obsessive compulsive disorder and social phobia through exposure/response prevention and cognitive behavioral therapy. Clinical Case Studies, 9, 125-134.
9.
FarrisS. G.McLeanC. P.Van MeterP. E.SimpsonH. B.FoaE. B. (2013). Treatment response, symptom remission and wellness in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 74, 685-690.
10.
FerrisT. S.MillsJ. P.HanstockT. L. (2012). Exposure and response prevention in the treatment of distressing and repugnant thoughts and images. Clinical Case Studies, 11, 140-151.
11.
FlessnerC. A.WoodsD. W.FranklinM. E.CashinS. E.KeuthenN. J., & Trichotillomania Learning Center-Scientific Advisory Board. (2008). The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A): Development of an instrument for the assessment of “focused” and “automatic” hair pulling. Journal of Psychopathology and Behavioral Assessment, 30, 20-30. doi:10.1007/s10862-007-9073-x
12.
FoaE. B.GoldsteinA. (1978). Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis. Behavior Therapy, 9, 821-829. doi:10.1016/S0005-7894(78)80013-6
13.
FoaE. B.YadinE.LichnerT. K. (2012). Treatments That Work. Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2nd ed.). New York, NY: Oxford University Press.
14.
FranklinM. E.AbramowitzJ. S.KozakM. J.LevittJ. T.FoaE. B. (2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68, 594-602. doi:10.1037/0022-006X.68.4.594
15.
GoodmanW. K.PriceL. H.RasmussenS. A.MazureC.FleischmannR. L.HillC. L.. . . CharneyD. S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011. doi:10.1001/archpsyc.1989.01810110048007
16.
GordonW. M. (2002). Sexual obsessions and OCD. Sexual and Relationship Therapy, 17, 343-354.
17.
HerguetaT.BakerR.DunbarG. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59, 22-33.
18.
KeeleyM. L.StorchE. A.MerloL. J.GeffkenG. R. (2008). Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clinical Psychology Review, 28, 118-130. doi:10.1016/j.cpr.2007.04.003
19.
LinehanM. M. (2015). DBT® skills training manual (2nd ed.). New York, NY: Guilford Press.
20.
Mataix-ColsD.MarksI. M.GreistJ. H.KobakK. A.BaerL. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychotherapy and Psychosomatics, 71, 255-262. doi:10.1159/000064812
21.
McKayD.AbramowitzJ. S.CalamariJ. E.KyriosM.RadomskyA.SookmanD.. . . WilhelmS. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283-313. doi:10.1016/j.cpr.2004.04.003
22.
McKayD.SookmanD.NezirogluF.WilhelmS.SteinD. J.KyriosM.. . . VealeD. (2015). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry Research, 225, 236-246. doi:10.1016/j.psychres.2015.02.004
23.
OverbeekT.SchruersK.VermettenE.GriezE. (2002). Comorbidity of obsessive-compulsive disorder and depression: Prevalence, symptom severity, and treatment effect. The Journal of Clinical Psychiatry, 63, 1106-1112.
24.
RicciardiJ. N.McNallyR. J. (1995). Depressed mood is related to obsessions, but not to compulsions, in obsessive-compulsive disorder. Journal of Anxiety Disorders, 9, 249-256. doi:10.1016/0887-6185(95)00006-A
25.
RitterM. R.Hazlett-StevensH. (2006). The use of exposure and ritual prevention in the treatment of harm obsessions with covert compulsions. Clinical Case Studies, 5(6), 455-476.
26.
RuscioA. M.SteinD. J.ChiuW. T.KesslerR. C. (2010). The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry, 15, 53-63. doi:10.1038/mp.2008.94
SheehanD. V.LecrubierY.SheehanK. H.AmorimP.JanavsJ.WeillerE.DunbarG. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59, 22-33.
29.
WheatonM. G.HuppertJ. D.FoaE. B.SimpsonH. B. (2016). How important is the therapeutic alliance in treating obsessive-compulsive disorder with exposure and response prevention? An empirical report. Clinical Neuropsychiatry, 13, 88-93.
30.
WilliamsM. T.CrozierM.PowersM. (2011). Treatment of sexual-orientation obsessions in obsessive-compulsive disorder using exposure and ritual prevention. Clinical Case Studies, 10, 53-66.
31.
WilliamsM. T.FarrisS. G. (2011). Sexual orientation obsessions in obsessive-compulsive disorder: Prevalence and correlates. Psychiatry Research, 187, 156-159.
32.
WoodsD. W.WetterneckC. T.FlessnerC. A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44, 639-656. doi:10.1016/j.brat.2005.05.006
33.
ZandbergL. J.ZangY.McLeanC. P.YehR.SimpsonH. B.FoaE. B. (2015). Change in obsessive-compulsive symptoms mediates subsequent change in depressive symptoms during exposure and response prevention. Behaviour Research and Therapy, 68, 76-81. doi:10.1016/j.brat.2015.03.005
